# JENNIFER M. PHAM DMD PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** DOWNTOWN FAMILY DENTAL OF LEESBURG
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376190744
- **Authorized official:** DR. JENNIFER MINH PHAM DMD (PRESIDENT)
- **Authorized official phone:** (703) 629-5088

## Contact information

- **Practice address:** 18 WIRT ST SW, LEESBURG, VA 20175-2915
- **Practice address phone:** (703) 777-5600
- **Mailing address:** 42550 STIRES DR, CHANTILLY, VA 20152-6655
- **Mailing address phone:** (703) 629-5088

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 1223P0700X | Prosthodontics | — | NULL | — |
| 1223P0700X | Prosthodontics | — | — | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | NULL | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | — | — |

## Other

- **Enumeration date:** 08/21/2019
- **Last updated:** 08/21/2019