MEDICARE: DR. JULIE DIEP TRAN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0401411048	VA

General Provider Information

NPI Number	:	1033283213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE DIEP TRAN D.D.S.

Provider Business Mailing Address
First Line	:	1012 BLENHEIM AVE
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22902-6213
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 LITTLE FALLS ST
Second Line	:	SUITE 506
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-4302
Country	:	US
Telephone Number	:	703-532-3300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	07/08/2007

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