Organization
FAIR LAKES FAMILY AND COSMETIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANNAH P TRAN DDS (DENTIST, PRESIDENT)
(703) 273-4505
Entity
Organization
Contact information
Practice address
12110 MONUMENT DR STE A, FAIRFAX, VA 22033-5553
(703) 273-4505
(703) 273-5757
Mailing address
12110 MONUMENT DR STE A, FAIRFAX, VA 22033-5553
(703) 273-4505
(703) 273-5757
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401410709
VA
Other
Enumeration date
03/05/2012
Last updated
03/05/2012
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