NPIMap

Organization Active NPI

Goose Creek Village Dental

  • Dental Clinic/Center
  • Ashburn, VA
National Provider Identifier
1902207327
Registry record updated Sep 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
0401413573 Issued in VA
Legal business name
GOOSE CREEK VILLAGE DENTAL
Practice address
21001 Sycolin Rd
Suite 240
Ashburn, VA 20147-4073
Phone
(703) 723-4224
Fax
(703) 723-4220
NPI assigned
Sep 5, 2014
Last updated
Sep 5, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2014

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

Authorized official

Name
Michael H Kim, DDSNPI 1659385367
Title
Dentist / Partner
Phone
(703) 723-4224

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 0401413573 VA Primary

Addresses

Primary practice location

21001 Sycolin Rd
Suite 240
Ashburn, VA 20147-4073

Mailing address

21001 Sycolin Rd
Suite 240
Ashburn, VA 20147-4073
Phone (703) 723-4224

National Provider Directory

National Provider Directory

Locations

21001 Sycolin Rd
Ste 240
Ashburn, VA 20147
Phone (703) 723-4224

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1409875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409875200000",
    "number": "1902207327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21001 SYCOLIN RD",
            "address_2": "SUITE 240",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201474073",
            "telephone_number": "703-723-4224",
            "fax_number": "703-723-4220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21001 SYCOLIN RD",
            "address_2": "SUITE 240",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201474073",
            "telephone_number": "703-723-4224",
            "fax_number": "703-723-4220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOSE CREEK VILLAGE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-05",
        "last_updated": "2014-09-05",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "DENTIST / PARTNER",
        "authorized_official_telephone_number": "703-723-4224",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "VA",
            "license": "0401413573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ashburn, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2014; 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.