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General NPI Number Information
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NPI Number | 1912415647
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Entity Type | Organization
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Legal Business Name | MAI T PHAN, DDS
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Dates
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Enumeration Date | 01/16/2018
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Last Update Date | 01/16/2018
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Provider Practice Location Address
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Address Line | 4001 9TH ST N STE 218
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City | ARLINGTON
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State | VA
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Zip | 22203-1900
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Country | US
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Telephone | 703-522-0510
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Fax | 703-522-0511
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Provider Business Mailing Address
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Address Line | 4001 9TH ST N STE 218
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City | ARLINGTON
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State | VA
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Zip | 22203-1900
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Country | US
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Telephone | 703-522-0510
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Fax | 703-522-0511
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Authorized Official
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Title or Position | PRESIDENT
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Name | TUYET-MAI THI PHAN
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Credential | DDS
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Telephone | 703-522-0510
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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 | VA7134
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License Number State | VA
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