Provider Demographics
NPI:1720259807
Name:HENRY, ROLIN S (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROLIN
Middle Name:S
Last Name:HENRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 ANDRUS RD
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 RD STE 2
Practice Address - Street 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
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014105081223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0017156Medicaid