Healthcare Provider Details

I. General information

NPI: 1720259807
Provider Name (Legal Business Name): ROLIN S. HENRY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 ANDRUS RD STE 2
ALEXANDRIA VA
22306-3167
US

IV. Provider business mailing address

7900 ANDRUS RD SUITE #2
ALEXANDRIA VA
22306-3167
US

V. Phone/Fax

Practice location:
  • Phone: 703-780-4422
  • Fax: 703-780-2722
Mailing address:
  • Phone: 703-780-4422
  • Fax: 703-780-2722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401410508
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: