Provider Demographics
NPI:1194815399
Name:FASSNACHT, STEPHEN P (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:P
Last Name:FASSNACHT
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 1:10236 FAIRE COMMONS CT
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2857
Mailing Address - Country:US
Mailing Address - Phone:703-400-3675
Mailing Address - Fax:
Practice Address - Street 1:8500 EXECUTIVE PARK AVE STE 208
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2253
Practice Address - Country:US
Practice Address - Phone:703-400-3675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA53381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice