# DENTAL ONE ASSOCIATES (OLD DOMINION) PLLC

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

## Provider details

- **NPI number:** 1710390042
- **Authorized official:** MICHAEL COLE (VP INSURANCE PLAN MANAGEMENT)
- **Authorized official phone:** (727) 726-1611

## Contact information

- **Practice address:** 9942 MAIN ST, FAIRFAX, VA 22031-3901
- **Practice address phone:** (703) 273-6622
- **Mailing address:** 9942 MAIN ST, FAIRFAX, VA 22031-3901

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | VA | Yes |

## Other

- **Enumeration date:** 06/04/2014
- **Last updated:** 06/04/2014