Provider Demographics
NPI:1629674973
Name:OFD PC
Entity Type:Organization
Organization Name:OFD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-281-6201
Mailing Address - Street 1:3050 CHAIN BRIDGE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2834
Mailing Address - Country:US
Mailing Address - Phone:703-281-6201
Mailing Address - Fax:
Practice Address - Street 1:3050 CHAIN BRIDGE RD STE 201
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2834
Practice Address - Country:US
Practice Address - Phone:703-281-6201
Practice Address - Fax:703-281-6208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-10
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty