Organization
ANH H PHAM DDS & BARRY R MAHARAJ DDS PC
Active
Other names
Chantilly Oral Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KAITI ROSE GRIM CMOM CERT MEDICAL OF (ADMINISTRATIVE DIRECTOR)
(703) 668-9494
Entity
Organization
Contact information
Practice address
3910 CENTERVILLE RD, STE 110, CHANTILLY, VA 20151-3280
(703) 668-9494
(703) 668-9495
Mailing address
3910 CENTERVILLE RD, STE 110, CHANTILLY, VA 20151-3280
(703) 668-9494
(703) 668-9495
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
0401006304
VA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
0401410305
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1006881
UNITED HEALTH CARE
—
01
—
105288
TRIGON BCBS ANTHEM
—
01
—
105289
TRIGON BCBS ANTHEM
—
01
—
1667155
UNITED CONCORDIA
—
01
—
1696192
UNITED CONCORDIA
—
01
—
392375
MAMSI OPT CHOICE ALLIANCE
—
01
—
555676
MAMSI OPT CHOICE ALLIANCE
—
Enumeration date
08/20/2006
Last updated
06/27/2013
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