Provider Demographics
NPI:1972800183
Name:FREDERICKSBURG FAMILY DENTISTRY
Entity Type:Organization
Organization Name:FREDERICKSBURG FAMILY DENTISTRY
Other - Org Name:MONTCLAIR FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HAYAT
Authorized Official - Middle Name:
Authorized Official - Last Name:NAJAFE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-548-8878
Mailing Address - Street 1:1740 CARL D SILVER PKWY
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4962
Mailing Address - Country:US
Mailing Address - Phone:540-548-8878
Mailing Address - Fax:540-548-8969
Practice Address - Street 1:1740 CARL D SILVER PKWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4962
Practice Address - Country:US
Practice Address - Phone:540-548-8878
Practice Address - Fax:540-548-8969
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAYAT NAJAFE D.D.S., P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-24
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410422122300000X
VA0401008911122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty