Provider Demographics
NPI:1831257062
Name:HAN, VICTOR (DDS)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43150 BROADLANDS CENTER PLAZA
Mailing Address - Street 2:SUITE #158
Mailing Address - City:BROADLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:20148
Mailing Address - Country:US
Mailing Address - Phone:703-726-1600
Mailing Address - Fax:703-726-1607
Practice Address - Street 1:43150 BROADLANDS CENTER PLAZA
Practice Address - Street 2:SUITE #158
Practice Address - City:BROADLANDS
Practice Address - State:VA
Practice Address - Zip Code:20148
Practice Address - Country:US
Practice Address - Phone:703-726-1600
Practice Address - Fax:703-726-1607
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014101761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice