# DENTAL IMPLANT SPECIALISTS OF VIRGINIA, PC

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

## Provider details

- **NPI number:** 1558066001
- **Authorized official:** MIKE GOLPA (OWNER DENTIST)
- **Authorized official phone:** (702) 768-7840

## Contact information

- **Practice address:** 1500 CORNERSIDE BLVD STE 600, TYSONS, VA 22182-2441
- **Practice address phone:** (703) 620-3040
- **Mailing address:** 3500 MAPLE AVE STE 1600, DALLAS, TX 75219-3936
- **Mailing address phone:** (909) 732-0191

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |
| 1223G0001X | General Practice Dentistry | — | NULL | — |
| 1223G0001X | General Practice Dentistry | — | — | — |
| 1223P0700X | Prosthodontics | — | NULL | — |
| 1223P0700X | Prosthodontics | — | — | — |

## Other

- **Enumeration date:** 04/04/2023
- **Last updated:** 04/06/2023