Healthcare Provider Details

I. General information

NPI: 1174118723
Provider Name (Legal Business Name): FOCUS DENTAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2021
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7617 LITTLE RIVER TPKE STE 910
ANNANDALE VA
22003-2618
US

IV. Provider business mailing address

7617 LITTLE RIVER TPKE STE 910
ANNANDALE VA
22003-2618
US

V. Phone/Fax

Practice location:
  • Phone: 703-462-9092
  • Fax:
Mailing address:
  • Phone: 703-462-9092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. NORACHAI PHISUTHIKUL
Title or Position: OWNER
Credential: DDS
Phone: 703-462-9092