Individual provider Active NPI

Anh-Minh Phan, D.D.S.

  • Prosthodontics
  • Alexandria, VA
National Provider Identifier
1033281803
Registry record updated Sep 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthodonticsTaxonomy code 1223P0700X
License
8285 Issued in VA
Practice address
1421 Prince St Ste 140
Alexandria, VA 22314-2771
Phone
(703) 549-1331
Fax
(703) 549-0480
NPI assigned
Nov 15, 2006
Last updated
Sep 8, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 8, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 8285 VA
Prosthodontics 1223P0700X 8285 VA Primary

Addresses

Primary practice location

1421 Prince St Ste 140
Alexandria, VA 22314-2771

Mailing address

1421 Prince St Ste 140
Alexandria, VA 22314-2771
Phone (703) 549-1331

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective Jun 26, 2017 through Jun 26, 2027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
8285VAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Alexandria Old Town Dental PLLC CurrentSince Sep 13, 2020 Accepting new patients

Locations

1421 Prince St
Ste 140
Alexandria, VA 22314
Phone (703) 549-1331

312 S Washington St
Ste 5A
Alexandria, VA 22314

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599523200000",
    "number": "1033281803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1421 PRINCE ST STE 140",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223142771",
            "telephone_number": "703-549-1331",
            "fax_number": "703-549-0480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421 PRINCE ST STE 140",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223142771",
            "telephone_number": "703-549-1331",
            "fax_number": "703-549-0480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "ANH-MINH",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-15",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "8285",
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "VA",
            "license": "8285",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexandria, VA

Sources for this page

Verify at the official NPI Registry.