Deep Roots Periodontics Pllc

LBN: Deep Roots Periodontics Pllc
Deep Roots Periodontics Pllc is an health care organization with primary practice located at 11130 Fairfax Blvd Suite 100, Fairfax VA 22030-5035. The organization recently has only one registered license in Dental Providers / Periodontics, which is considered as the primary health care specialty. Deep Roots Periodontics Pllc can be contacted via phone (954) 536-1111, or through Kang, Taeheon via phone (954) 536-1111.

Contact Information

Primary practice address
11130 Fairfax Blvd Suite 100 Fairfax VA 22030-5035
Phone: (954) 536-1111
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Kang, Taeheon D.D.S., M.S.
Phone: (954) 536-1111

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Periodontics 1223P0300X 0401-413327 Virginia

Profile Details

NPI number 1255695243
LBN Legal business name Deep Roots Periodontics Pllc
DBA Doing business as
Authorized official Kang, Taeheon D.D.S., M.S.
Entity Organization
Organization subpart 1 No
Enumeration date Jun 25th, 2012
Last updated Jun 25th, 2012 - about 13 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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