Provider Demographics
NPI:1265547947
Name:ANH H PHAM DDS & BARRY R MAHARAJ DDS PC
Entity type:Organization
Organization Name:ANH H PHAM DDS & BARRY R MAHARAJ DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAITI
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:GRIM
Authorized Official - Suffix:
Authorized Official - Credentials:CMOM CERT MEDICAL OF
Authorized Official - Phone:703-668-9494
Mailing Address - Street 1:3910 CENTERVILLE RD
Mailing Address - Street 2:STE 110
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-3280
Mailing Address - Country:US
Mailing Address - Phone:703-668-9494
Mailing Address - Fax:703-668-9495
Practice Address - Street 1:3910 CENTERVILLE RD
Practice Address - Street 2:STE 110
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-3280
Practice Address - Country:US
Practice Address - Phone:703-668-9494
Practice Address - Fax:703-668-9495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014103051223S0112X
VA04010063041223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
105289OtherTRIGON BCBS ANTHEM
555676OtherMAMSI OPT CHOICE ALLIANCE
1696192OtherUNITED CONCORDIA
1006881OtherUNITED HEALTH CARE
105288OtherTRIGON BCBS ANTHEM
1667155OtherUNITED CONCORDIA
392375OtherMAMSI OPT CHOICE ALLIANCE