Organization
PREMIUM FAMILY DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VU NGUYEN D.D.S (PRESIDENT)
(703) 606-8458
Entity
Organization
Contact information
Practice address
6328 RICHMOND HWY STE F, ALEXANDRIA, VA 22306-6408
(703) 606-8458
Mailing address
3618 HIGHLAND PL, FAIRFAX, VA 22033-2718
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401410920
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010141605
—
VA
Enumeration date
02/08/2011
Last updated
02/08/2011
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