Provider Demographics
NPI:1891201802
Name:ORAL AND FACIAL SURGERY CENTER OF VIRGINIA
Entity Type:Organization
Organization Name:ORAL AND FACIAL SURGERY CENTER OF VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HASNAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHINWARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:857-247-6414
Mailing Address - Street 1:3887 FAIRFAX RIDGE RD APT 313
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7544
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3787 FETTLER PARK DR STE A8
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22025-1946
Practice Address - Country:US
Practice Address - Phone:857-247-6414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-28
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415066261QD0000X
VA0438000358261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental