Provider Demographics
NPI:1003088030
Name:BROOKFIELD DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:BROOKFIELD DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PARIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:TUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-913-1377
Mailing Address - Street 1:7010 BROOKFIELD PLZ
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-2914
Mailing Address - Country:US
Mailing Address - Phone:703-913-1377
Mailing Address - Fax:703-891-2288
Practice Address - Street 1:7010 BROOKFIELD PLZ
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2914
Practice Address - Country:US
Practice Address - Phone:703-913-1377
Practice Address - Fax:703-891-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014107971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty