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General NPI Number Information
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NPI Number | 1659882595
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Entity Type | Organization
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Legal Business Name | SHININGSTARS PEDIATRIC DENTISTRY PC
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Dates
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Enumeration Date | 10/18/2017
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Last Update Date | 06/14/2022
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Provider Practice Location Address
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Address Line | 435 INGRAHAM ST NE
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City | WASHINGTON
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State | DC
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Zip | 20011
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Country | US
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Telephone | 202-600-4833
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Fax | 202-635-5555
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Provider Business Mailing Address
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Address Line | PO BOX 10083
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City | MCLEAN
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State | VA
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Zip | 22102
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Country | US
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Telephone | 703-586-7119
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GINA CUC PHAM
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Credential | DDS
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Telephone | 703-586-7119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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