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General NPI Number Information
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NPI Number | 1639827678
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Entity Type | Individual
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Provider Name | BRANDON KHOI TRAN DMD
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Gender | Male
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Dates
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Enumeration Date | 03/17/2022
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Last Update Date | 03/17/2022
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Provider Practice Location Address
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Address Line | 9671D MAIN ST
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City | FAIRFAX
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State | VA
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Zip | 22031-3742
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Country | US
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Telephone | 703-503-5211
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Fax |
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Provider Business Mailing Address
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Address Line | 1185 WINDROCK DR
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City | MC LEAN
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State | VA
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Zip | 22102-1547
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Country | US
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Telephone | 703-635-9007
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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 | 0401417812
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License Number State | VA
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