Organization
BARRY R. MAHARAJ, DDS & ANH H. PHAM, DDS, PC
Active
Other names
Lansdowne Oral Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KAITI R GRIM CMOM (ADMINISTRATIVE DIRCT)
(703) 723-7858
Entity
Organization
Contact information
Practice address
19441 GOLF VISTA PLAZA, SUITE 130, LANSDOWNE, VA 20176
(703) 723-7858
(703) 723-7882
Mailing address
19441 GOLF VISTA PLAZA, SUITE 130, LANSDOWNE, VA 20176
(703) 723-7858
(703) 723-7882
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
0401006304
VA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
0401410305
VA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
0401413171
VA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008000492
—
VA
05
—
008000531
—
VA
01
—
292375
MAMSI OP CHOICE ALLIANCE
MD
01
—
384081
BCBS
VA
01
—
384338
BCBS
VA
01
—
455676
MAMSI OP CHOICE ALLIANCE
MD
Enumeration date
11/20/2006
Last updated
08/21/2013
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