Fairfax Advanced Dentistry, P.C.

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

FAIRFAX ADVANCED DENTISTRY, P.C.

Practice address

3930 Pender Dr Ste 150
Fairfax, VA 22030-0986

Phone

(703) 650-9299

NPI assigned

Jan 23, 2019

Organization subpart

No

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

Authorized official

Name

Alex Osinovsky

Title

Owner

Phone

(703) 861-8777

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1548201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548201600000",
    "number": "1902360068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3930 PENDER DR STE 150",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220300986",
            "telephone_number": "703-650-9299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3930 PENDER DR STE 150",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220300986",
            "telephone_number": "703-650-9299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRFAX ADVANCED DENTISTRY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-23",
        "last_updated": "2019-01-23",
        "status": "A",
        "authorized_official_last_name": "OSINOVSKY",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-861-8777"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Fairfax, VA
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2019; 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.