Provider Demographics
NPI:1033281803
Name:PHAN, ANH-MINH (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANH-MINH
Middle Name:
Last Name:PHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 PRINCE ST STE 140
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2771
Mailing Address - Country:US
Mailing Address - Phone:703-549-1331
Mailing Address - Fax:703-549-0480
Practice Address - Street 1:1421 PRINCE ST STE 140
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2771
Practice Address - Country:US
Practice Address - Phone:703-549-1331
Practice Address - Fax:703-549-0480
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA82851223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No1223G0001XDental ProvidersDentistGeneral Practice