# VIRIGINIA ORAL FACIAL & IMPLANT SURGERY

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

## Provider details

- **NPI number:** 1588867113
- **Authorized official:** DR. MICHAEL TIMOTHY GOCKE DDS (OWNER)
- **Authorized official phone:** (703) 388-2805

## Contact information

- **Practice address:** 7601 LEWINSVILLE RD, SUITE 203, MCLEAN, VA 22102-2814
- **Practice address phone:** (703) 388-2805
- **Practice address fax:** (703) 388-2806
- **Mailing address:** PO BOX 1049, FAYETTEVILLE, AR 72702-1049
- **Mailing address phone:** (479) 464-5824
- **Mailing address fax:** (479) 725-2395

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 0401411538 | VA | Yes |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | 0401411538 | VA | — |
| 2082S0099X | Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician | 0401411538 | VA | — |

## Other

- **Enumeration date:** 06/10/2007
- **Last updated:** 07/21/2008