Provider Demographics
NPI:1972790376
Name:RESTON SUNRISE DENTISTRY, PC
Entity Type:Organization
Organization Name:RESTON SUNRISE DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HANAH
Authorized Official - Middle Name:HANH
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-860-4149
Mailing Address - Street 1:12359 SUNRISE VALLEY DR STE 330
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-3463
Mailing Address - Country:US
Mailing Address - Phone:703-860-4149
Mailing Address - Fax:
Practice Address - Street 1:12359 SUNRISE VALLEY DR STE 330
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3463
Practice Address - Country:US
Practice Address - Phone:703-860-4149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-29
Last Update Date:2007-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410411122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty