Individual
DR. GINA CUC PHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
12602 LAKE RIDGE DR, WOODBRIDGE, VA 22192-2335
(703) 490-5050
(703) 490-1155
Mailing address
PO BOX 10083, MC LEAN, VA 22102-8083
(703) 626-8196
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
13454
MD
1223P0221X
Pediatric Dentistry
Primary
0401411775
VA
1223P0221X
Pediatric Dentistry
DEN1001433
DC
Other
Enumeration date
03/13/2007
Last updated
03/17/2021
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