Data Breach Notifications

Entity Information

  • Type of Organization: Healthcare
  • Entity Name: Fairfax Oral and Maxillofacial Surgery
  • Street Address: 10530 Rosehaven St., Suite 111
  • City: Fairfax
  • State, or Country if outside the US: VA
  • Zip Code: 22030

Submitted By

  • Name: Michael J. Waters
  • Title: Shareholder
  • Firm name (if different than entity): Polsinelli PC
  • Telephone Number: 312-463-6212
  • Email Address: Mwaters@polsinelli.com
  • Relationship to entity whose information was compromised: Attorney

Breach Information

  • Total number of persons affected (including residents): 235,931
  • Total number of Maine residents affected: 33
  • If the number of Maine residents exceeds 1,000, have the consumer reporting agencies been notified:
  • Date(s) Breach Occured: 05/15/2023
  • Date Breach Discovered: 09/14/2023
  • Description of the Breach:
    • External system breach (hacking)
  • Information Acquired - Name or other personal identifier in combination with: Driver's License Number or Non-Driver Identification Card Number

Notification and Protection Services

  • Type of Notification: Written
  • Date(s) of consumer notification: 08/18/2023, 08/21/2021, and 10/12/2023
  • Copy of notice to affected Maine residents: Template F Guarantor Adult 1YR CM_rev1 (91577530v1).pdf
  • Date of any previous (within 12 months) breach notifications:
  • Were identity theft protection services offered: Yes
  • If yes, please provide the duration, the provider of the service and a brief description of the service: 12 months, Experian, Experian Credit3B