Provider Demographics
NPI:1336272491
Name:NGUYEN, TRACEY
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19450 DEERFIELD AVE
Mailing Address - Street 2:STE.485
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-6820
Mailing Address - Country:US
Mailing Address - Phone:703-723-7810
Mailing Address - Fax:703-723-7812
Practice Address - Street 1:19450 DEERFIELD AVE
Practice Address - Street 2:STE.485
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-6820
Practice Address - Country:US
Practice Address - Phone:703-723-7810
Practice Address - Fax:703-723-7812
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014105691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice