Individual
DR. FUCONG TIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BDS, PHD
Contact information
Practice address
12040 W BROAD STREET, HENRICO, VA 23233
(804) 364-7010
(706) 721-6778
Mailing address
1612 HUGUENOT ROAD, MIDLOTHIAN, VA 23113
(804) 794-9789
(804) 419-1059
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
0401418375
VA
1223E0200X
Endodontics
37946
TX
1223E0200X
Endodontics
DE61171559
WA
1223E0200X
Endodontics
DNF000434
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003241248A
—
GA
05
—
ZX0434
—
SC
Enumeration date
05/17/2018
Last updated
07/09/2024
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