Organization
MCLEAN ORAL & MAXILLOFACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIC A FORETICH D.D.S., M.A. (OWNER)
(703) 893-8800
Entity
Organization
Contact information
Practice address
1515 CHAIN BRIDGE RD, SUITE 206, MC LEAN, VA 22101-4451
(703) 893-8800
(703) 893-8845
Mailing address
10440 NEW ASCOT DR, GREAT FALLS, VA 22066-3421
(703) 893-8800
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
3844
VA
Other
Enumeration date
08/08/2007
Last updated
08/08/2007
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