Provider Demographics
NPI:1669888483
Name:SPRINGDALE KIDZ DENTISTRY, PLLC
Entity type:Organization
Organization Name:SPRINGDALE KIDZ DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-462-8855
Mailing Address - Street 1:5047 BACKLICK RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-6045
Mailing Address - Country:US
Mailing Address - Phone:703-462-8855
Mailing Address - Fax:
Practice Address - Street 1:5047 BACKLICK RD
Practice Address - Street 2:SUITE A
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-6045
Practice Address - Country:US
Practice Address - Phone:703-462-8855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014106631223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty