OrganizationActive
Deep Roots Periodontics PLLC
NPI 1255695243 · Periodontics · Fairfax, VA
Deep Roots Periodontics PLLC is a Periodontics organization in Fairfax, VA (NPI 1255695243).
Provider details
- NPI number
- 1255695243
- Entity type
- Organization
- Primary specialty
- PeriodonticsDental Providers
- Organization subpart
- No
- Authorized official
- Taeheon Kang, Periodontis(954) 536-1111
- License
- 0401-413327 (VA)
Specialties & taxonomies
Dental Providers
Profile Score
Detailed profile(79/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
14 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
11130 Fairfax Blvd
Suite 100
Fairfax, VA 22030-5035
Phone: (954) 536-1111
Street-level locationGet directions
Mailing address
11130 Fairfax Blvd
Fairfax, VA 22030-5035
Registry dates
- Enumerated
- 2012-06-25
- Last updated
- 2012-06-25
Frequently asked questions
- What is Deep Roots Periodontics PLLC's NPI number?
- Deep Roots Periodontics PLLC's National Provider Identifier (NPI) is 1255695243, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Deep Roots Periodontics PLLC?
- Deep Roots Periodontics PLLC is classified in the NPPES registry as Periodontics (Dental Providers).
- Where is Deep Roots Periodontics PLLC located?
- Deep Roots Periodontics PLLC's practice location on file with NPPES is 11130 Fairfax Blvd, Fairfax, VA 22030-5035.
- What is Deep Roots Periodontics PLLC's phone number?
- The practice phone number listed in the NPPES registry for Deep Roots Periodontics PLLC is (954) 536-1111.
- Who is the authorized official for Deep Roots Periodontics PLLC?
- The authorized official listed on Deep Roots Periodontics PLLC's NPPES record is Taeheon Kang, Periodontis. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Deep Roots Periodontics PLLC's NPI active?
- Yes — Deep Roots Periodontics PLLC's NPI (1255695243) is active in the NPPES registry as of the last update on 2012-06-25.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.