Healthcare Provider Details

I. General information

NPI: 1891434353
Provider Name (Legal Business Name): ALEXANDRA TRAM MAI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8218 WISCONSIN AVE STE 401
BETHESDA MD
20814-3142
US

IV. Provider business mailing address

8218 WISCONSIN AVE STE 401
BETHESDA MD
20814-3142
US

V. Phone/Fax

Practice location:
  • Phone: 301-656-0331
  • Fax:
Mailing address:
  • Phone: 301-656-0331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number17412
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: