Healthcare Provider Details

I. General information

NPI: 1477080612
Provider Name (Legal Business Name): BENZON HAMILTON HUYNH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3613 CHAIN BRIDGE RD
FAIRFAX VA
22030
US

IV. Provider business mailing address

15207 GENERAL STEVENS CT
CHANTILLY VA
20151-1319
US

V. Phone/Fax

Practice location:
  • Phone: 703-893-6680
  • Fax:
Mailing address:
  • Phone: 571-426-8048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401416045
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401416045
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: