# JACK C PHASS JR DDS INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** JACK C PHASS JR DDS INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1295928208
- **Legal business name:** JACK C PHASS JR DDS INC
- **Authorized official:** DR. DEAN J PHASS DDS (PRESIDENT)
- **Authorized official phone:** (703) 824-0055

## Contact information

- **Practice address:** 5205 LEESBURG PIKE, SUITE 101, FALLS CHURCH, VA 22041-3802
- **Practice address phone:** (703) 824-0055
- **Practice address fax:** (703) 998-9859
- **Mailing address:** 5205 LEESBURG PIKE, SUITE 101, FALLS CHURCH, VA 22041-3802
- **Mailing address phone:** (703) 824-0055
- **Mailing address fax:** (703) 998-9859

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 0401007124 | VA | — |
| 1223G0001X | General Practice Dentistry | 0401006623 | VA | Yes |
| 1223G0001X | General Practice Dentistry | 0401008644 | VA | — |

## Other

- **Enumeration date:** 08/22/2007
- **Last updated:** 08/22/2007