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General NPI Number Information
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NPI Number | 1972838027
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Entity Type | Organization
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Legal Business Name | IMPRESSION DENTAL, PC
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Dates
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Enumeration Date | 10/07/2009
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Last Update Date | 10/07/2009
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Provider Practice Location Address
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Address Line | 6167 FULLER CT
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City | ALEXANDRIA
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State | VA
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Zip | 22310-2541
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Country | US
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Telephone | 703-822-0670
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Fax | 703-822-0650
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Provider Business Mailing Address
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Address Line | 6167 FULLER CT
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City | ALEXANDRIA
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State | VA
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Zip | 22310-2541
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Country | US
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Telephone | 703-822-0670
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Fax | 703-822-0650
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Authorized Official
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Title or Position | DENTIST
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Name | DR. STEVE HOANG NGUYEN
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Credential | DDS
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Telephone | 703-822-0670
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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 | 0401412610
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License Number State | VA
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