# WALNUT DENTAL ASSOCIATES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275125809
- **Authorized official:** DR. ROLIN S HENRY DDS (MEMBER)
- **Authorized official phone:** (703) 638-1420

## Contact information

- **Practice address:** 3930 WALNUT ST STE 240, FAIRFAX, VA 22030-4738
- **Practice address phone:** (703) 638-1420
- **Practice address fax:** (703) 638-1421
- **Mailing address:** 3930 WALNUT ST STE 240, FAIRFAX, VA 22030-4738
- **Mailing address phone:** (703) 638-1420
- **Mailing address fax:** (703) 638-1421

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | — |
| 122300000X | Dentist | — | — | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 02/04/2021
- **Last updated:** 02/04/2021