Healthcare Provider Details

I. General information

NPI: 1891825741
Provider Name (Legal Business Name): GOLDEN DENTAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 10/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200-A LYNGATE COURTE
BURKE VA
22015
US

IV. Provider business mailing address

3320 NOBLE POND WAY SUITE 109
WOODBRIDGE VA
22193
US

V. Phone/Fax

Practice location:
  • Phone: 703-640-1000
  • Fax:
Mailing address:
  • Phone: 703-640-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ROGER A HENNIGH
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 703-640-1000