=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598347619
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DOANTRANG T NGUYEN DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2021
-----------------------------------------------------
Last Update Date | 02/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13880 BRADDOCK RD STE 109
-----------------------------------------------------
City | CENTREVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20121-2460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-893-6680
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22574 HIGHCROFT TER
-----------------------------------------------------
City | BRAMBLETON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20148-8049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-475-2717
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DEN2000152
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 0401417825
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------