Provider Demographics
NPI:1497075220
Name:OASIS PEDIATRIC DENTAL CARE, PC
Entity Type:Organization
Organization Name:OASIS PEDIATRIC DENTAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAETON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-854-1710
Mailing Address - Street 1:800 W BROAD ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3142
Mailing Address - Country:US
Mailing Address - Phone:703-854-1710
Mailing Address - Fax:
Practice Address - Street 1:800 W BROAD ST
Practice Address - Street 2:SUITE 307
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3142
Practice Address - Country:US
Practice Address - Phone:703-854-1710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014115081223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty