Provider Demographics
NPI:1154345189
Name:NGUYEN, BICHLAN THI (DDS)
Entity type:Individual
Prefix:
First Name:BICHLAN
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LAN
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:9671 MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3750
Mailing Address - Country:US
Mailing Address - Phone:703-503-5211
Mailing Address - Fax:703-503-5288
Practice Address - Street 1:9671 MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3750
Practice Address - Country:US
Practice Address - Phone:703-503-5211
Practice Address - Fax:703-503-5288
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007526122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist