Provider Demographics
NPI:1518268861
Name:KOH & ASSOCIATES, DDS, P.C.
Entity Type:Organization
Organization Name:KOH & ASSOCIATES, DDS, P.C.
Other - Org Name:FAIRFAX PROSTHODONTICS & DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PRIMARY DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:I
Authorized Official - Last Name:KOH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD, PC
Authorized Official - Phone:703-865-8829
Mailing Address - Street 1:10721 MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6913
Mailing Address - Country:US
Mailing Address - Phone:703-865-8829
Mailing Address - Fax:
Practice Address - Street 1:10721 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6913
Practice Address - Country:US
Practice Address - Phone:703-865-8829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411961122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty