Provider Demographics
NPI:1174648927
Name:FAVIS, RAYMUND V (DDS)
Entity Type:Individual
Prefix:
First Name:RAYMUND
Middle Name:V
Last Name:FAVIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4103 CHAIN BRIDGE RD
Mailing Address - Street 2:B100
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4107
Mailing Address - Country:US
Mailing Address - Phone:703-267-6627
Mailing Address - Fax:703-627-6931
Practice Address - Street 1:4103 CHAIN BRIDGE RD
Practice Address - Street 2:B100
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4107
Practice Address - Country:US
Practice Address - Phone:703-267-6627
Practice Address - Fax:703-627-6931
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010076831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice