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General NPI Number Information
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NPI Number | 1336574219
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Entity Type | Organization
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Legal Business Name | ANGEL HANDS DENTISTRY PLLC
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Dates
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Enumeration Date | 09/10/2013
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Last Update Date | 09/10/2013
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Provider Practice Location Address
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Address Line | 13824 SMOKETOWN RD
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City | WOODBRIDGE
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State | VA
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Zip | 22192-4210
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Country | US
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Telephone | 571-285-2980
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Fax | 571-659-2055
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Provider Business Mailing Address
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Address Line | 13824 SMOKETOWN RD
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City | WOODBRIDGE
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State | VA
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Zip | 22192-4210
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Country | US
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Telephone | 571-285-2980
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Fax | 571-659-2055
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Authorized Official
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Title or Position | DENTIST
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Name | DR. THOAIVAN PHAN
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Credential | D.D.S
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Telephone | 571-285-2980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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