Provider Demographics
NPI:1174715262
Name:SHUE JEN CHUANG D.D.S. & DAVID W. LUCHT D.D.S. PLC
Entity type:Organization
Organization Name:SHUE JEN CHUANG D.D.S. & DAVID W. LUCHT D.D.S. PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:SHUE JEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-803-9223
Mailing Address - Street 1:13880 BRADDOCK RD STE 311
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2462
Mailing Address - Country:US
Mailing Address - Phone:703-803-9223
Mailing Address - Fax:703-803-9570
Practice Address - Street 1:13880 BRADDOCK RD STE 311
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2462
Practice Address - Country:US
Practice Address - Phone:703-803-9223
Practice Address - Fax:703-803-9570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010074031223G0001X
VA04010074271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty