MEDICARE: LANDMARK FAMILY DENTAL PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0401412117	VA

General Provider Information

NPI Number	:	1346557980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANDMARK FAMILY DENTAL PLC

Provider Business Mailing Address
First Line	:	6204 LITTLE RIVER TPKE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22312-1714
Country	:	US
Telephone Number	:	703-658-3000
Fax Number	:	703-658-3550

Provider Business Practice Location Address
First Line	:	6204 LITTLE RIVER TPKE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22312-1714
Country	:	US
Telephone Number	:	703-658-3000
Fax Number	:	703-658-3550

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. KERI TRAN
Credential	:	DDS
Telephone Number	:	703-658-3000

Provider Enumeration Date	:	09/02/2010
Last Update Date	:	09/02/2010

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