Provider Demographics
NPI:1104497619
Name:HOANG, DYLAN MINH (DMD)
Entity type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:MINH
Last Name:HOANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10710 OAK PL
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2818
Mailing Address - Country:US
Mailing Address - Phone:703-638-4290
Mailing Address - Fax:
Practice Address - Street 1:14901 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-2921
Practice Address - Country:US
Practice Address - Phone:703-753-7077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014175551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice