Healthcare Provider Details

I. General information

NPI: 1356099105
Provider Name (Legal Business Name): TINGTING ZHU DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2022
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3613 CHAIN BRIDGE RD STE A
FAIRFAX VA
22030-3238
US

IV. Provider business mailing address

3613 CHAIN BRIDGE RD STE A
FAIRFAX VA
22030-3238
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TINGTING ZHU FREED
Title or Position: DENTIST/OWNER
Credential: DMD
Phone: 703-893-6680