Elbalila Goguen, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

0401412159 Issued in VA

Practice address

21001 Sycolin Rd Ste 320
Ashburn, VA 20147-4074

Phone

(703) 858-4700

Fax

(703) 858-4703

NPI assigned

Jun 25, 2008

Last updated

Jul 23, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1214352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595462400000",
    "number": "1740441468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21001 SYCOLIN RD STE 320",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201474074",
            "telephone_number": "703-858-4700",
            "fax_number": "703-858-4702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21001 SYCOLIN RD STE 320",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201474074",
            "telephone_number": "703-858-4700",
            "fax_number": "703-858-4703"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2930 W Hundred Rd",
            "address_purpose": "LOCATION",
            "city": "Chester",
            "state": "VA",
            "postal_code": "238312126",
            "country_code": "US",
            "telephone_number": "804-751-0146",
            "fax_number": "804-768-4283",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOGUEN",
        "first_name": "ELBALILA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-25",
        "last_updated": "2020-07-23",
        "certification_date": "2020-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401412159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Ashburn, VA
• Providers in Ashburn, VA by specialty
• Dentist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2020; 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.