Organization
DENTAL IMPLANT SPECIALISTS OF VIRGINIA, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE GOLPA (OWNER DENTIST)
(702) 768-7840
Entity
Organization
Contact information
Practice address
1500 CORNERSIDE BLVD STE 600, TYSONS, VA 22182-2441
(703) 620-3040
Mailing address
3500 MAPLE AVE STE 1600, DALLAS, TX 75219-3936
(909) 732-0191
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0700X
Prosthodontics
—
—
Other
Enumeration date
04/04/2023
Last updated
04/06/2023
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