Provider Demographics
NPI:1184866857
Name:FAMILY AND COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:FAMILY AND COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:QUANG
Authorized Official - Middle Name:NGOC HUY
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-698-5155
Mailing Address - Street 1:8626 LEE HWY
Mailing Address - Street 2:#203
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2135
Mailing Address - Country:US
Mailing Address - Phone:703-698-5155
Mailing Address - Fax:703-698-5888
Practice Address - Street 1:8626 LEE HWY
Practice Address - Street 2:#203
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2135
Practice Address - Country:US
Practice Address - Phone:703-698-5155
Practice Address - Fax:703-698-5888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014114511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty