Provider Demographics
NPI:1932236189
Name:FALAIYE, VICTOR OLUSEGUN
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:OLUSEGUN
Last Name:FALAIYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17865 MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-2411
Mailing Address - Country:US
Mailing Address - Phone:703-499-9006
Mailing Address - Fax:703-441-7927
Practice Address - Street 1:17865 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026-2411
Practice Address - Country:US
Practice Address - Phone:703-499-9006
Practice Address - Fax:703-441-7927
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014102371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice