Provider Demographics
NPI:1588716534
Name:JASON FARR FAVAGEHI DDC PC
Entity type:Organization
Organization Name:JASON FARR FAVAGEHI DDC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:FARR
Authorized Official - Last Name:FAVAGEHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-356-1200
Mailing Address - Street 1:8304 C OLD COURT HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182
Mailing Address - Country:US
Mailing Address - Phone:703-356-1200
Mailing Address - Fax:703-356-6742
Practice Address - Street 1:8304 C OLD COURT HOUSE RD
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182
Practice Address - Country:US
Practice Address - Phone:703-356-1200
Practice Address - Fax:703-356-6742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007352122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty