Provider Demographics
NPI:1720446099
Name:CHRISTINE MAI DDS OF WOODBRIDGE INC
Entity Type:Organization
Organization Name:CHRISTINE MAI DDS OF WOODBRIDGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:LAN
Authorized Official - Last Name:MAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-593-8889
Mailing Address - Street 1:13885 HEDGEWOOD DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-7928
Mailing Address - Country:US
Mailing Address - Phone:571-285-5023
Mailing Address - Fax:571-285-5398
Practice Address - Street 1:13885 HEDGEWOOD DR
Practice Address - Street 2:SUITE 209
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-7928
Practice Address - Country:US
Practice Address - Phone:571-285-5023
Practice Address - Fax:571-285-5398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008744122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty