Provider Demographics
NPI:1942994231
Name:PHAN, QUINNIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:QUINNIE
Middle Name:
Last Name:PHAN
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 1:11721 KARBON HILL CT APT T2
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-2345
Mailing Address - Country:US
Mailing Address - Phone:602-369-7228
Mailing Address - Fax:
Practice Address - Street 1:361 WALKER DR STE 204
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-4364
Practice Address - Country:US
Practice Address - Phone:540-341-4111
Practice Address - Fax:540-341-4991
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014184971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice