Provider Demographics
NPI:1508985813
Name:TINGLING, FLAVIA DESIREE (DDS)
Entity Type:Individual
Prefix:DR
First Name:FLAVIA
Middle Name:DESIREE
Last Name:TINGLING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9010 LORTON STATION BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-4792
Mailing Address - Country:US
Mailing Address - Phone:703-339-3993
Mailing Address - Fax:
Practice Address - Street 1:9010 LORTON STATION BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-4792
Practice Address - Country:US
Practice Address - Phone:703-339-3993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010194501223G0001X
NY0506521223P0221X
VA04014125811223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice