MEDICARE: DR. LOAN THI DANG DDS

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	122300000X	Dentist	0401007533	VA

General Provider Information

NPI Number	:	1275518763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOAN THI DANG DDS

Provider Business Mailing Address
First Line	:	6404 SEVEN CORNERS PL
Second Line	:	STE J
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2010
Country	:	US
Telephone Number	:	703-536-8864
Fax Number	:	703-536-4290

Provider Business Practice Location Address
First Line	:	6404 SEVEN CORNERS PL
Second Line	:	STE J
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2010
Country	:	US
Telephone Number	:	703-536-8864
Fax Number	:	703-536-4290

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

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	04/15/2015

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