# GOOSE CREEK VILLAGE DENTAL

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

## Provider details

- **NPI number:** 1902207327
- **Authorized official:** MICHAEL H KIM DDS (DENTIST / PARTNER)
- **Authorized official phone:** (703) 723-4224

## Contact information

- **Practice address:** 21001 SYCOLIN RD, SUITE 240, ASHBURN, VA 20147-4073
- **Practice address phone:** (703) 723-4224
- **Practice address fax:** (703) 723-4220
- **Mailing address:** 21001 SYCOLIN RD, SUITE 240, ASHBURN, VA 20147-4073
- **Mailing address phone:** (703) 723-4224
- **Mailing address fax:** (703) 723-4220

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 0401413573 | VA | Yes |

## Other

- **Enumeration date:** 09/05/2014
- **Last updated:** 09/05/2014