Provider Demographics
NPI:1063076602
Name:DENTIST OF AMERICA, PC
Entity type:Organization
Organization Name:DENTIST OF AMERICA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THIEN
Authorized Official - Middle Name:VAN DAO
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-347-3522
Mailing Address - Street 1:5217 CATHER RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-3719
Mailing Address - Country:US
Mailing Address - Phone:703-347-3522
Mailing Address - Fax:703-942-6683
Practice Address - Street 1:4800 CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-1803
Practice Address - Country:US
Practice Address - Phone:703-936-6522
Practice Address - Fax:703-942-6683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-29
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty