Provider Demographics
NPI:1558886580
Name:EUN, MARC DH (DMD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:DH
Last Name:EUN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:DONG HWUI
Other - Middle Name:
Other - Last Name:EUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4511 PLATEAU DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6281
Mailing Address - Country:US
Mailing Address - Phone:703-732-3996
Mailing Address - Fax:
Practice Address - Street 1:4511 PLATEAU DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6281
Practice Address - Country:US
Practice Address - Phone:907-333-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014159161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice