Provider Demographics
NPI:1528232428
Name:CHRISTINE L. MAI, D.D.S., P.C.
Entity Type:Organization
Organization Name:CHRISTINE L. MAI, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-971-9737
Mailing Address - Street 1:6422 GROVEDALE DR
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-2570
Mailing Address - Country:US
Mailing Address - Phone:703-971-9737
Mailing Address - Fax:703-971-4446
Practice Address - Street 1:6422 GROVEDALE DR
Practice Address - Street 2:SUITE 101A
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-2570
Practice Address - Country:US
Practice Address - Phone:703-971-9737
Practice Address - Fax:703-971-4446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010087441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty