Provider Demographics
NPI:1134287014
Name:TRAN-YEN-PHONG NGUYEN, DMD, INC.
Entity Type:Organization
Organization Name:TRAN-YEN-PHONG NGUYEN, DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAN-YEN-PHONG
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-536-9886
Mailing Address - Street 1:PO BOX 3628
Mailing Address - Street 2:
Mailing Address - City:MERRIFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22116-3628
Mailing Address - Country:US
Mailing Address - Phone:703-536-9886
Mailing Address - Fax:
Practice Address - Street 1:7297 LEE HWY
Practice Address - Street 2:SUITE D
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-1707
Practice Address - Country:US
Practice Address - Phone:703-536-9886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010086041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty