# PREMIUM FAMILY DENTAL PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063718104
- **Authorized official:** DR. VU NGUYEN D.D.S (PRESIDENT)
- **Authorized official phone:** (703) 606-8458

## Contact information

- **Practice address:** 6328 RICHMOND HWY STE F, ALEXANDRIA, VA 22306-6408
- **Practice address phone:** (703) 606-8458
- **Mailing address:** 3618 HIGHLAND PL, FAIRFAX, VA 22033-2718

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 0401410920 | VA | Yes |

## Other

- **Enumeration date:** 02/08/2011
- **Last updated:** 02/08/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 010141605 | — | VA |