# SHENANDOAH ORAL & MAXILLOFACIAL SURGERY INC

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

## Provider details

- **NPI number:** 1972940393
- **Authorized official:** TARA ANN FUGATE (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (703) 897-8983

## Contact information

- **Practice address:** 170 GARBER LN, WINCHESTER, VA 22602-4386
- **Practice address phone:** (540) 667-0100
- **Practice address fax:** (540) 667-0121
- **Mailing address:** 170 GARBER LN, WINCHESTER, VA 22602-4386
- **Mailing address phone:** (540) 667-0100
- **Mailing address fax:** (540) 667-0121

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 0401006414 | VA | Yes |

## Other

- **Enumeration date:** 05/24/2013
- **Last updated:** 09/18/2019