Provider Demographics
NPI:1609953728
Name:ALEXANDER OSINOVSKY, DDS PC
Entity Type:Organization
Organization Name:ALEXANDER OSINOVSKY, DDS PC
Other - Org Name:TYSONS DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/ PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:OSINOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-848-8906
Mailing Address - Street 1:8230 BOONE BLVD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2621
Mailing Address - Country:US
Mailing Address - Phone:703-848-8906
Mailing Address - Fax:703-848-8909
Practice Address - Street 1:8230 BOONE BLVD
Practice Address - Street 2:SUITE 410
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2621
Practice Address - Country:US
Practice Address - Phone:703-848-8906
Practice Address - Fax:703-848-8909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010088771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty