Provider Demographics
NPI:1639788862
Name:STAFFORD ORAL SURGERY P.C.
Entity Type:Organization
Organization Name:STAFFORD ORAL SURGERY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:D
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-304-1276
Mailing Address - Street 1:13580 GROUPE DR STE 305
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4165
Mailing Address - Country:US
Mailing Address - Phone:703-304-1276
Mailing Address - Fax:
Practice Address - Street 1:481 GARRISONVILLE RD STE 103
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1601
Practice Address - Country:US
Practice Address - Phone:540-779-0170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty