Provider Demographics
NPI:1518330133
Name:OPTIMAL DENTAL CENTER, INC
Entity Type:Organization
Organization Name:OPTIMAL DENTAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:QUYEN
Authorized Official - Middle Name:NGOC
Authorized Official - Last Name:DANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-389-2943
Mailing Address - Street 1:8303 ARLINGTON BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2903
Mailing Address - Country:US
Mailing Address - Phone:703-573-1313
Mailing Address - Fax:703-573-6180
Practice Address - Street 1:8303 ARLINGTON BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2903
Practice Address - Country:US
Practice Address - Phone:703-573-1313
Practice Address - Fax:703-573-6180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410698261QD0000X
VA0401412564261QD0000X
VA0401414108261QD0000X
VA0401006304261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental