# FAIRFAX ORAL AND MAXILLOFACIAL SURGERY PC

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

## Provider details

- **NPI number:** 1710907134
- **Authorized official:** JULIA M SPRADLIN (ADMINISTRATOR)
- **Authorized official phone:** (703) 385-5777

## Contact information

- **Practice address:** 10530 ROSEHAVEN ST, SUITE 111, FAIRFAX, VA 22030-2840
- **Practice address phone:** (703) 385-5777
- **Practice address fax:** (703) 591-5386
- **Mailing address:** 10530 ROSEHAVEN ST, SUITE 111, FAIRFAX, VA 22030-2840
- **Mailing address phone:** (703) 385-5777
- **Mailing address fax:** (703) 591-5386

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 07/20/2006
- **Last updated:** 04/27/2009