# NORTHERN VIRGINIA CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639259773
- **Authorized official:** MISS BRENDA LEE PICENTE (PRACTICE MANAGER)
- **Authorized official phone:** (703) 449-8888

## Contact information

- **Practice address:** 4211 FAIRFAX CORNER EAST AVE, SUITE \# 235, FAIRFAX, VA 22030
- **Practice address phone:** (703) 449-8888
- **Practice address fax:** (703) 449-9888
- **Mailing address:** 4211 FAIRFAX CORNER EAST AVE, SUITE \# 235, FAIRFAX, VA 22030
- **Mailing address phone:** (703) 449-8888
- **Mailing address fax:** (703) 449-9888

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 0401410440 | VA | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 0438000163 | VA | Yes |

## Other

- **Enumeration date:** 10/16/2006
- **Last updated:** 05/25/2011