MEDICARE: DR. BRANDON KHOI TRAN DMD

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	0401417812	VA

General Provider Information

NPI Number	:	1639827678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDON KHOI TRAN DMD

Provider Business Mailing Address
First Line	:	1185 WINDROCK DR
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-1547
Country	:	US
Telephone Number	:	703-635-9007
Fax Number	:

Provider Business Practice Location Address
First Line	:	9671D MAIN ST
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-3742
Country	:	US
Telephone Number	:	703-503-5211
Fax Number	:

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

Provider Enumeration Date	:	03/17/2022
Last Update Date	:	03/17/2022

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