Organization
FAIRFAX ORTHODONTIC ASSOCIATES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LUCY L. MCCABE (ADMINISTRATOR)
(703) 719-5828
Entity
Organization
Contact information
Practice address
12011 LEE JACKSON MEMORIAL HWY, FAIRFAX, VA 22033-3310
(703) 691-9061
Mailing address
12011 LEE JACKSON MEMORIAL HWY, FAIRFAX, VA 22033-3310
(703) 691-9061
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
0401007980
VA
Other
Enumeration date
04/12/2007
Last updated
08/22/2020
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