Healthcare Provider Details

I. General information

NPI: 1598347619
Provider Name (Legal Business Name): DOANTRANG T NGUYEN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRANG T NGUYEN

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13880 BRADDOCK RD STE 109
CENTREVILLE VA
20121-2460
US

IV. Provider business mailing address

22574 HIGHCROFT TER
BRAMBLETON VA
20148-8049
US

V. Phone/Fax

Practice location:
  • Phone: 703-893-6680
  • Fax:
Mailing address:
  • Phone: 240-475-2717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN2000152
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401417825
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: