Organization
DENTAL ONE ASSOCIATES (OLD DOMINION) PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL COLE (VP INSURANCE PLAN MANAGEMENT)
(727) 726-1611
Entity
Organization
Contact information
Practice address
9942 MAIN ST, FAIRFAX, VA 22031-3901
(703) 273-6622
Mailing address
9942 MAIN ST, FAIRFAX, VA 22031-3901
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
VA
Other
Enumeration date
06/04/2014
Last updated
06/04/2014
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