Fairfax Orthodontic Associates, PLLC

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

0401007980 Issued in VA

Legal business name

FAIRFAX ORTHODONTIC ASSOCIATES, PLLC

Practice address

12011 Lee Jackson Memorial Hwy
Fairfax, VA 22033-3310

Phone

(703) 691-9061

NPI assigned

Apr 12, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Lucy L. McCabe

Title

Administrator

Phone

(703) 719-5828

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497979504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12011 LEE JACKSON MEMORIAL HWY",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220333310",
            "telephone_number": "703-691-9061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12011 LEE JACKSON MEMORIAL HWY",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220333310",
            "telephone_number": "703-691-9061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRFAX ORTHODONTIC ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCCABE",
        "authorized_official_first_name": "LUCY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "703-719-5828",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "VA",
            "license": "0401007980",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Preferred Provider Organization in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Preferred Provider Organization in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.