# FAIRFAX ADVANCED DENTISTRY, P.C.

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

## Provider details

- **NPI number:** 1902360068
- **Authorized official:** ALEX OSINOVSKY (OWNER)
- **Authorized official phone:** (703) 861-8777

## Contact information

- **Practice address:** 3930 PENDER DR STE 150, FAIRFAX, VA 22030-0986
- **Practice address phone:** (703) 650-9299
- **Mailing address:** 3930 PENDER DR STE 150, FAIRFAX, VA 22030-0986
- **Mailing address phone:** (703) 650-9299

## Taxonomy

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

## Other

- **Enumeration date:** 01/23/2019
- **Last updated:** 01/23/2019