Healthcare Provider Details

I. General information

NPI: 1205073087
Provider Name (Legal Business Name): BAIK, DUONG, MA, NGUYEN & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 N HIGHLAND ST SUITE 300 (THIRD FLOOR)
ARLINGTON VA
22201-2196
US

IV. Provider business mailing address

1050 N HIGHLAND ST SUITE 300 (THIRD FLOOR)
ARLINGTON VA
22201-2196
US

V. Phone/Fax

Practice location:
  • Phone: 703-527-3888
  • Fax: 703-527-2038
Mailing address:
  • Phone: 703-527-3888
  • Fax: 703-527-2038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number0401411232
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401410983
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401410421
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401412250
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401412334
License Number StateVA
# 6
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401410721
License Number StateVA

VIII. Authorized Official

Name: MR. ANDY A.T. MA
Title or Position: DDS/ VICE PRESIDENT
Credential: DDS
Phone: 703-527-3888