Provider Demographics
NPI:1891825741
Name:GOLDEN DENTAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:GOLDEN DENTAL ASSOCIATES, P.C.
Other - Org Name:EMBRACE FAMILY SMILES OF BURKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:A
Authorized Official - Last Name:HENNIGH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-640-1000
Mailing Address - Street 1:3320 NOBLE POND WAY
Mailing Address - Street 2:SUITE 109
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193
Mailing Address - Country:US
Mailing Address - Phone:703-640-1000
Mailing Address - Fax:
Practice Address - Street 1:5200-A LYNGATE COURTE
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015
Practice Address - Country:US
Practice Address - Phone:703-640-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty