Provider Demographics
NPI:1134207608
Name:PHAN, MAI T (DDS)
Entity type:Individual
Prefix:
First Name:MAI
Middle Name:T
Last Name:PHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:TUYET MAI
Other - Middle Name:T
Other - Last Name:PHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4001 N 9TH ST
Mailing Address - Street 2:SUITE 218
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203
Mailing Address - Country:US
Mailing Address - Phone:703-522-0510
Mailing Address - Fax:703-522-0511
Practice Address - Street 1:4001 N 9TH ST
Practice Address - Street 2:SUITE 218
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203
Practice Address - Country:US
Practice Address - Phone:703-522-0510
Practice Address - Fax:703-522-0511
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA7134122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist