Healthcare Provider Details

I. General information

NPI: 1295033173
Provider Name (Legal Business Name): THIEN DAO D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5960 KINGSTOWNE TOWNE CTR SUITE 140
ALEXANDRIA VA
22315-5896
US

IV. Provider business mailing address

5960 KINGSTOWNE TOWNE CTR SUITE 140
ALEXANDRIA VA
22315-5896
US

V. Phone/Fax

Practice location:
  • Phone: 703-719-9210
  • Fax: 703-719-6330
Mailing address:
  • Phone: 703-719-9210
  • Fax: 703-719-6330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401412862
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: