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FAIR LAKES DENTAL SERVICES
NPI 1154447589
Dentist - General Practice in Fairfax, VA

Active since March 21, 2007
11166 FAIRFAX BLVD STE 400, FAIRFAX, VA 22030(703) 691-3015(703) 691-3016 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Fair Lakes Dental Services NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FAIR LAKES DENTAL SERVICES (NPI 1154447589) is a healthcare organization registered as a general practice in Fairfax, Virginia and active in the NPI registry since March 2007. The organization lists Keith Jonathan Wilson, Owner President, as its authorized official.

NPPES Registry Identity

NPI1154447589
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameKEITH J WILSON DDS PC
Location Address11166 FAIRFAX BLVD STE 400Fairfax, VA 22030-5017
Mailing Address11166 Fairfax Blvd Ste 400Fairfax, VA 22030-5017 · (703) 691-3015 · Fax (703) 691-3016
Phone(703) 691-3015
Fax(703) 691-3016
Organization SubpartNo
Authorized OfficialKeith Jonathan WilsonOwner President · (703) 691-3015
Enumeration DateMarch 21, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1154447589 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in VA · 0401008681
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
11166 FAIRFAX BLVD STE 400, Fairfax, VA 22030
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Other Names 1

Doing Business AsFair Lakes Dental Services

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C.
Orthopaedic Surgery
11166 FAIRFAX BLVD STE 400
FAIRFAX, VA 22030
Fairfax City (571) 367-9849

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Keith J Wilson Dds PC's NPI number?

The NPI number for Keith J Wilson Dds PC is 1154447589. It was assigned to this organization in the NPPES registry on March 21, 2007. The provider is doing business as Fair Lakes Dental Services.

Where is Keith J Wilson Dds PC located?

Keith J Wilson Dds PC is located at 11166 Fairfax Blvd Ste 400, Fairfax, VA 22030. The listed phone number is (703) 691-3015.

What is Keith J Wilson Dds PC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Keith J Wilson Dds PC was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.