# JAE M CHONG DMD PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Centreville Dental Design
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831928654
- **Authorized official:** JAE CHONG DMD (PRESIDENT)
- **Authorized official phone:** (703) 825-1191

## Contact information

- **Practice address:** 14215F CENTREVILLE SQ, CENTREVILLE, VA 20121-2301
- **Practice address phone:** (703) 825-1191
- **Mailing address:** 14215F CENTREVILLE SQ, CENTREVILLE, VA 20121-2301
- **Mailing address phone:** (703) 825-1191

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 07/30/2024
- **Last updated:** 08/13/2024