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General NPI Number Information
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NPI Number | 1063076602
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Entity Type | Organization
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Legal Business Name | DENTIST OF AMERICA, PC
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Dates
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Enumeration Date | 04/29/2019
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Last Update Date | 06/04/2021
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Provider Practice Location Address
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Address Line | 4800 CHEROKEE AVE
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City | ALEXANDRIA
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State | VA
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Zip | 22312-1803
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Country | US
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Telephone | 703-936-6522
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Fax | 703-942-6683
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Provider Business Mailing Address
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Address Line | 5217 CATHER RD
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City | SPRINGFIELD
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State | VA
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Zip | 22151-3719
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Country | US
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Telephone | 703-347-3522
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Fax | 703-942-6683
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Authorized Official
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Title or Position | PRESIDENT
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Name | THIEN VAN DAO LE
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Credential | DDS
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Telephone | 703-347-3522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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