Organization
SHENANDOAH ORAL & MAXILLOFACIAL SURGERY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA ANN FUGATE (PRACTICE ADMINISTRATOR)
(703) 897-8983
Entity
Organization
Contact information
Practice address
170 GARBER LN, WINCHESTER, VA 22602-4386
(540) 667-0100
(540) 667-0121
Mailing address
170 GARBER LN, WINCHESTER, VA 22602-4386
(540) 667-0100
(540) 667-0121
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
0401006414
VA
Other
Enumeration date
05/24/2013
Last updated
09/18/2019
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