Provider Demographics
NPI:1972823375
Name:BAHNG, JOYCE H (DMD)
Entity type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:H
Last Name:BAHNG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46161 WESTLAKE DR STE 310
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5871
Mailing Address - Country:US
Mailing Address - Phone:703-774-9699
Mailing Address - Fax:703-444-4309
Practice Address - Street 1:46161 WESTLAKE DR STE 310
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-5871
Practice Address - Country:US
Practice Address - Phone:703-774-9699
Practice Address - Fax:703-444-4309
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0233191223G0001X
390200000X
VA04014164291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program