Provider Demographics
NPI:1285891911
Name:FAIRFAX SMILES DENTAL CARE PLC
Entity type:Organization
Organization Name:FAIRFAX SMILES DENTAL CARE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:SOYFER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD PHD JD
Authorized Official - Phone:703-359-9080
Mailing Address - Street 1:3930 PENDER DR
Mailing Address - Street 2:SUITE110
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-0985
Mailing Address - Country:US
Mailing Address - Phone:703-359-9080
Mailing Address - Fax:
Practice Address - Street 1:3930 PENDER DR
Practice Address - Street 2:SUITE110
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-0985
Practice Address - Country:US
Practice Address - Phone:703-359-9080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014104071223G0001X, 261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty