Provider Demographics
NPI:1225374317
Name:SMILEY DU DENTAL
Entity Type:Organization
Organization Name:SMILEY DU DENTAL
Other - Org Name:DR. KHANH DR, FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHANH
Authorized Official - Middle Name:Q
Authorized Official - Last Name:DU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-578-4221
Mailing Address - Street 1:3610 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1042
Mailing Address - Country:US
Mailing Address - Phone:703-578-4221
Mailing Address - Fax:703-578-1228
Practice Address - Street 1:3610 FOREST DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1042
Practice Address - Country:US
Practice Address - Phone:703-578-4221
Practice Address - Fax:703-578-1228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014137151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty