Organization
FAIRFAX DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JESSICA HAGUE (OFFICE MANAGER)
(703) 273-1443
Entity
Organization
Contact information
Practice address
4000 VIRGINIA ST, FAIRFAX, VA 22032-1047
(703) 273-1443
(703) 273-9186
Mailing address
4000 VIRGINIA ST, FAIRFAX, VA 22032-1047
(703) 273-1443
(703) 273-9186
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401410745
VA
Other
Enumeration date
05/09/2017
Last updated
05/09/2017
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