Individual
DR. THOAIVAN PHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S
Contact information
Practice address
13824 SMOKETOWN RD, WOODBRIDGE, VA 22192-4210
(571) 285-2980
(571) 659-2055
Mailing address
8819 BURKE RD, BURKE, VA 22015-3619
(703) 912-7279
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401007092
VA
Other
Enumeration date
11/01/2006
Last updated
08/06/2013
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