| Chantilly Green Dental Care | |
|
13035 Lee Jackson Memorial Hwy Ste D Fairfax VA 22033-2039 | |
| (703) 378-2466 | |
| (703) 378-2467 |
| Full Name | Chantilly Green Dental Care |
|---|---|
| Speciality | Dentist |
| Location | 13035 Lee Jackson Memorial Hwy Ste D, Fairfax, Virginia |
| Authorized Official Name and Position | Anh Tu Pham (PRESIDENT) |
| Authorized Official Contact | 7033782466 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Chantilly Green Dental Care 13035 Lee Jackson Memorial Hwy Ste D Fairfax VA 22033-2039 Ph: (703) 378-2466 | Chantilly Green Dental Care 13035 Lee Jackson Memorial Hwy Ste D Fairfax VA 22033-2039 Ph: (703) 378-2466 |
| NPI Number | 1457542144 |
|---|---|
| Provider Enumeration Date | 08/07/2007 |
| Last Update Date | 08/07/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457542144 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 0401410353 (Virginia) | Primary |
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