Dental Implant Specialists of Virginia, PC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

DENTAL IMPLANT SPECIALISTS OF VIRGINIA, PC

Practice address

1500 Cornerside Blvd Ste 600
Tysons, VA 22182-2441

Phone

(703) 620-3040

NPI assigned

Apr 4, 2023

Last updated

Apr 6, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mike Golpa

Title

Owner Dentist

Phone

(702) 768-7840

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1680566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680739200000",
    "number": "1558066001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 MAPLE AVE STE 1600",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752193936",
            "telephone_number": "909-732-0191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 CORNERSIDE BLVD STE 600",
            "city": "TYSONS",
            "state": "VA",
            "postal_code": "221822441",
            "telephone_number": "703-620-3040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL IMPLANT SPECIALISTS OF VIRGINIA, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-04",
        "last_updated": "2023-04-06",
        "certification_date": "2023-04-06",
        "status": "A",
        "authorized_official_last_name": "GOLPA",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "702-768-7840"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2023; 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.