Healthcare Provider Details

I. General information

NPI: 1740793355
Provider Name (Legal Business Name): AMY TON DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 11/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11868 SUNRISE VALLEY DR STE 100
RESTON VA
20191-3320
US

IV. Provider business mailing address

11868 SUNRISE VALLEY DR STE 100
RESTON VA
20191-3320
US

V. Phone/Fax

Practice location:
  • Phone: 703-860-6700
  • Fax: 703-860-6657
Mailing address:
  • Phone: 703-860-6700
  • Fax: 703-860-6657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401414171
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number0401414161
License Number StateVA

VIII. Authorized Official

Name: DR. AMY TON
Title or Position: OWNER
Credential: DDS
Phone: 703-943-8686