1891201802 NPI number — ORAL AND FACIAL SURGERY CENTER OF VIRGINIA

Table of content: (NPI 1891201802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891201802 NPI number — ORAL AND FACIAL SURGERY CENTER OF VIRGINIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORAL AND FACIAL SURGERY CENTER OF VIRGINIA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891201802
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3887 FAIRFAX RIDGE RD APT 313
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22030-7544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3787 FETTLER PARK DR STE A8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUMFRIES
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22025-1946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
857-247-6414
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2017

Additional Information

Authorized Official

Authorized Official Last Name:
SHINWARI
Authorized Official First Name:
HASNAIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
857-247-6414

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  0401415066 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QS0112X , with the licence number: 0438000358 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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