=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033009006
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE THUY-TRANG QUACH DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2025
-----------------------------------------------------
Last Update Date | 07/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2130 S PLEASANT VALLEY RD
-----------------------------------------------------
City | WINCHESTER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22601-7003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-773-2516
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13055 CAVENDISH RUN CT
-----------------------------------------------------
City | CATHARPIN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20143-2424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-424-0574
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 0401419587
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------