Provider Demographics
NPI:1417279589
Name:SAXENA DENTAL FAIRFAX, PLC
Entity Type:Organization
Organization Name:SAXENA DENTAL FAIRFAX, PLC
Other - Org Name:ELITE SMILES DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAXENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-508-4421
Mailing Address - Street 1:20023 BELMONT STATION DR
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-6611
Mailing Address - Country:US
Mailing Address - Phone:703-508-4421
Mailing Address - Fax:703-953-2392
Practice Address - Street 1:3903 FAIR RIDGE DR
Practice Address - Street 2:SUITE 214
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2906
Practice Address - Country:US
Practice Address - Phone:703-877-0775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014104561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty