Provider Demographics
NPI:1093187510
Name:LONG D PHAM DDS PLLC
Entity Type:Organization
Organization Name:LONG D PHAM DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:NOHEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLASCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-237-7820
Mailing Address - Street 1:462 HERNDON PKWY
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-5233
Mailing Address - Country:US
Mailing Address - Phone:703-707-8500
Mailing Address - Fax:571-210-4410
Practice Address - Street 1:462 HERNDON PKWY
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5233
Practice Address - Country:US
Practice Address - Phone:703-707-8500
Practice Address - Fax:571-210-4410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412166122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty