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General NPI Number Information
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NPI Number | 1174043939
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Entity Type | Organization
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Legal Business Name | THREE CREEK DENTISTRY, LLC
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Dates
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Enumeration Date | 06/22/2017
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Last Update Date | 06/22/2017
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Provider Practice Location Address
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Address Line | 7236 MUNCASTER MILL RD
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City | DERWOOD
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State | MD
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Zip | 20855-1215
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Country | US
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Telephone | 703-474-5695
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Fax |
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Provider Business Mailing Address
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Address Line | 3409 WILSON BLVD UNIT 803
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City | ARLINGTON
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State | VA
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Zip | 22201-2246
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. VINH CHI TRINH
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Credential | DDS
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Telephone | 703-474-5695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 16285
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 16219
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License Number State | MD
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