Legacy Dental Implant of Herndon

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Legal business name

LEGACY DENTAL IMPLANT OF HERNDON

Practice address

208 Elden St
Herndon, VA 20170-4877

Phone

(646) 824-3829

NPI assigned

Jul 8, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Abdelrouf Suwid

Title

Owner

Phone

(646) 824-3829

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ahmed Matri, DDS

  • Endodontics
  • Oakton, VA
  • NPI 1386032597
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1751932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751932800000",
    "number": "1053201384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 ELDEN ST",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201704877",
            "telephone_number": "646-824-3829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 ELDEN ST",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201704877",
            "telephone_number": "646-824-3829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY DENTAL IMPLANT OF HERNDON",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-08",
        "last_updated": "2025-07-08",
        "certification_date": "2025-07-08",
        "status": "A",
        "authorized_official_last_name": "SUWID",
        "authorized_official_first_name": "ABDELROUF",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "646-824-3829"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hon K. Lee, L.AC., DIPL.O.M.
• Kevin J Lee, MD
• Kyung Jae Lee, D.C
• Matthew Lee, D.C.
• Patrick Kyle Lee
• Legacy Healing & Therapy Services LLC
• Legacy Hustle Care Solutions Inc
• Barbara Jean Lennon, LCSW
• Rachel Arlene Leopold
• Marilyn Lepage, MSPT, COMT, CHT

• Periodontics in Herndon, VA
• Providers in Herndon, VA by specialty
• Periodontics in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.