Healthcare Provider Details

I. General information

NPI: 1780953125
Provider Name (Legal Business Name): GOHO DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 HOLLAND RD STE 102
VIRGINIA BEACH VA
23452-2859
US

IV. Provider business mailing address

3720 HOLLAND RD STE 102
VIRGINIA BEACH VA
23452-2859
US

V. Phone/Fax

Practice location:
  • Phone: 240-501-6745
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401411064
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID R THROCKMORTON JR.
Title or Position: OWNER
Credential: DDS
Phone: 757-498-1663