MEDICARE: DR. THU PHAN GETKA 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	1223P0300X	Periodontics	08820	MD

General Provider Information

NPI Number	:	1811981426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THU PHAN GETKA DDS

Provider Business Mailing Address
First Line	:	5809 JOHNSON CT
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20817-3417
Country	:	US
Telephone Number	:	202-433-2080
Fax Number	:

Provider Business Practice Location Address
First Line	:	1016 BUCHANAN ST SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20374-5020
Country	:	US
Telephone Number	:	202-433-2480
Fax Number	:

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	07/08/2007

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