# DENTAL CENTER OF HERNDON

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

## Provider details

- **NPI number:** 1457608986
- **Authorized official:** DR. KENNETH QIU (DENTIST/PRESIDENT)
- **Authorized official phone:** (703) 318-7200

## Contact information

- **Practice address:** 1110 ELDEN ST., SUITE E108, HERNDON, VA 20170
- **Practice address phone:** (703) 318-7200
- **Practice address fax:** (703) 318-8668
- **Mailing address:** 1110 ELDEN ST., SUITE E108, HERNDON, VA 20170
- **Mailing address phone:** (703) 318-7200
- **Mailing address fax:** (703) 318-8668

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 401102428 | VA | Yes |

## Other

- **Enumeration date:** 08/15/2012
- **Last updated:** 08/15/2012