=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275700544
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAO T NGUYEN DDS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2008
-----------------------------------------------------
Last Update Date | 05/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8998 LORTON STATION BLVD SUITE E
-----------------------------------------------------
City | LORTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22079-4789
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-339-3898
-----------------------------------------------------
Fax | 703-261-7342
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8998 LORTON STATION BLVD SUITE E
-----------------------------------------------------
City | LORTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22079-4789
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-339-3898
-----------------------------------------------------
Fax | 703-261-7342
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DAO NGUYEN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 703-339-3898
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 0401410868
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------