Organization
FAIRFAX ORAL AND MAXILLOFACIAL SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIA M SPRADLIN (ADMINISTRATOR)
(703) 385-5777
Entity
Organization
Contact information
Practice address
10530 ROSEHAVEN ST, SUITE 111, FAIRFAX, VA 22030-2840
(703) 385-5777
(703) 591-5386
Mailing address
10530 ROSEHAVEN ST, SUITE 111, FAIRFAX, VA 22030-2840
(703) 385-5777
(703) 591-5386
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
07/20/2006
Last updated
04/27/2009
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