Healthcare Provider Details

I. General information

NPI: 1841917515
Provider Name (Legal Business Name): KRISTINA TRANG TA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 GROVE ST STE 303
HERNDON VA
20170-4793
US

IV. Provider business mailing address

7518 CHRISLAND CV
FALLS CHURCH VA
22042-7557
US

V. Phone/Fax

Practice location:
  • Phone: 703-223-3308
  • Fax:
Mailing address:
  • Phone: 703-223-3308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401419942
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number108181
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: