Dental One Associates (old Dominion) Pllc

NPI #1710390042 in Fairfax, Virginia

Provider Information

NPI Number: 1710390042
Entity Type: Organization
Organization Name: Dental One Associates (old Dominion) Pllc
Primary Specialty: Dentist
Enumeration Date: Jun 4, 2014
Last Updated: Jun 4, 2014

Practice Location

Address: 9942 MAIN ST
City: Fairfax
State: Virginia
ZIP Code: 22031-3901
Phone: (703) 273-6622

Authorized Official

Name: MICHAEL COLE
Title: VP INSURANCE PLAN MANAGEMENT
Phone: (727) 726-1611

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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