Provider Demographics
NPI:1750399572
Name:PHAN, PHUONG XUAN (DMD)
Entity type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:XUAN
Last Name:PHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 MARTHA CUSTIS DR
Mailing Address - Street 2:C6
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302
Mailing Address - Country:US
Mailing Address - Phone:703-931-6344
Mailing Address - Fax:703-931-1896
Practice Address - Street 1:1225 MARTHA CUSTIS DR
Practice Address - Street 2:C6
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302
Practice Address - Country:US
Practice Address - Phone:703-931-6344
Practice Address - Fax:703-931-1896
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410780122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist