Healthcare Provider Details

I. General information

NPI: 1841265634
Provider Name (Legal Business Name): DR TIMOTHY GOLIAN DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11230 WAPLES MILLROAD SUITE 150
FAIRFAX VA
22030
US

IV. Provider business mailing address

11230 WAPLES MILLROAD SUITE 150
FAIRFAX VA
22030
US

V. Phone/Fax

Practice location:
  • Phone: 703-273-8798
  • Fax: 703-273-4212
Mailing address:
  • Phone: 703-273-8798
  • Fax: 703-273-4212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number0401007887
License Number StateVA

VIII. Authorized Official

Name: DR. TIMOTHY GOLIAN
Title or Position: ENDODONTIST
Credential: DDS PC
Phone: 703-273-8798