OrganizationActive
Deep Roots Periodontics PLLC
NPI 1255695243 · Periodontics · Fairfax, VA
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
Practice location
11130 Fairfax Blvd
Suite 100
Fairfax, VA 22030-5035
Phone: (954) 536-1111
Approximate (ZIP-level) locationGet directions
Mailing address
11130 Fairfax Blvd
Fairfax, VA 22030-5035
Registry dates
- Enumerated
- 2012-06-25
- Last updated
- 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.