Individual
DR. JASON FARR FAVAGEHI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
8304 OLD COURTHOUSE RD STE C, VIENNA, VA 22182-3881
(703) 356-1200
Mailing address
8304 OLD COURTHOUSE RD STE C, VIENNA, VA 22182-3881
(703) 356-1200
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401007352
VA
Other
Enumeration date
03/23/2009
Last updated
03/23/2009
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