Data Breach Notifications

Entity Information

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

Submitted By

  • Name: Michael Waters
  • Title: Shareholder
  • Firm name (if different than entity): Polsinelli PC, 150 N. Riverside Plaza, Ste 3000, Chicago, IL 60606
  • Telephone Number: 312-463-6212
  • Email Address:
  • Relationship to entity whose information was compromised: Attorney

Breach Information

  • Total number of persons affected (including residents): 206944
  • Total number of Maine residents affected: 31
  • 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: 07/11/2023
  • 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 - 08/21/2023
  • Copy of notice to affected Maine residents: Fairfax - Template A - 1YR Adult CM.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