Provider Demographics
NPI:1912415647
Name:MAI T PHAN, DDS
Entity Type:Organization
Organization Name:MAI T PHAN, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TUYET-MAI
Authorized Official - Middle Name:THI
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-522-0510
Mailing Address - Street 1:4001 9TH ST N STE 218
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1900
Mailing Address - Country:US
Mailing Address - Phone:703-522-0510
Mailing Address - Fax:703-522-0511
Practice Address - Street 1:4001 9TH ST N STE 218
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1900
Practice Address - Country:US
Practice Address - Phone:703-522-0510
Practice Address - Fax:703-522-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA7134261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental