Provider Demographics
NPI:1174043939
Name:THREE CREEK DENTISTRY, LLC
Entity Type:Organization
Organization Name:THREE CREEK DENTISTRY, LLC
Other - Org Name:THREE CREEK DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINH
Authorized Official - Middle Name:CHI
Authorized Official - Last Name:TRINH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-474-5695
Mailing Address - Street 1:3409 WILSON BLVD UNIT 803
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-2246
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7236 MUNCASTER MILL RD
Practice Address - Street 2:
Practice Address - City:DERWOOD
Practice Address - State:MD
Practice Address - Zip Code:20855-1215
Practice Address - Country:US
Practice Address - Phone:703-474-5695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16219261QD0000X
MD16285261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1861805202OtherNPI
VA1770995243OtherNPI