Provider Demographics
NPI:1437275930
Name:PHAN, CHUONG CONG (DDS)
Entity Type:Individual
Prefix:
First Name:CHUONG
Middle Name:CONG
Last Name:PHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46161 WESTLAKE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:POTOMAC FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5871
Mailing Address - Country:US
Mailing Address - Phone:703-433-9999
Mailing Address - Fax:703-433-9998
Practice Address - Street 1:46161 WESTLAKE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:POTOMAC FALLS
Practice Address - State:VA
Practice Address - Zip Code:20165-5871
Practice Address - Country:US
Practice Address - Phone:703-433-9999
Practice Address - Fax:703-433-9998
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014104351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice