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General NPI Number Information
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NPI Number | 1366111080
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Entity Type | Organization
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Legal Business Name | NGOC NGUYEN DMD PLLC
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Dates
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Enumeration Date | 09/07/2021
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 5666 COLUMBIA PIKE STE A
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City | FALLS CHURCH
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State | VA
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Zip | 22041-2701
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Country | US
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Telephone | 703-417-9622
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Fax |
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Provider Business Mailing Address
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Address Line | 5666 COLUMBIA PIKE STE A
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City | FALLS CHURCH
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State | VA
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Zip | 22041-2701
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Country | US
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Telephone | 703-417-9622
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. NGOC BAO NGUYEN
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Credential | DMD
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Telephone | 703-973-4120
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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 |
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License Number State |
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