Provider Demographics
NPI:1093861395
Name:NOVA MICROENDODONTICS
Entity Type:Organization
Organization Name:NOVA MICROENDODONTICS
Other - Org Name:BESNERFABIOBRAMWELL DENTAL ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICEPRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:FABIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-569-0000
Mailing Address - Street 1:6120 BRANDON AVE
Mailing Address - Street 2:314
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-2522
Mailing Address - Country:US
Mailing Address - Phone:703-569-0000
Mailing Address - Fax:
Practice Address - Street 1:6120 BRANDON AVE
Practice Address - Street 2:314
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2522
Practice Address - Country:US
Practice Address - Phone:703-569-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty