Provider Demographics
NPI:1235231408
Name:ROLIN S HENRY DDS PC
Entity Type:Organization
Organization Name:ROLIN S HENRY DDS PC
Other - Org Name:ROLIN S HENRY DDS PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-780-4422
Mailing Address - Street 1:7900 ANDRUS ROAD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3167
Mailing Address - Country:US
Mailing Address - Phone:703-780-4422
Mailing Address - Fax:703-780-2722
Practice Address - Street 1:7900 ANDRUS ROAD
Practice Address - Street 2:SUITE #2
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3167
Practice Address - Country:US
Practice Address - Phone:703-780-4422
Practice Address - Fax:703-780-2722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410508122300000X
DCDEN1000038122300000X
MD12939122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0017156Medicaid