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General NPI Number Information
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NPI Number | 1396322517
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Entity Type | Individual
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Provider Name | BACH NGUYEN DDS
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Gender | Male
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Dates
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Enumeration Date | 03/24/2021
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 1500 CORNERSIDE BLVD STE 500
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City | TYSONS
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State | VA
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Zip | 22182-2440
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Country | US
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Telephone | 703-625-6229
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Fax |
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Provider Business Mailing Address
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Address Line | 4020 LAFAYETTE VILLAGE DR
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City | ANNANDALE
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State | VA
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Zip | 22003-1500
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Country | US
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Telephone | 571-830-4299
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DEN1002171
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401417315
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 17064
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License Number State | MD
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