Organization
VIRIGINIA ORAL FACIAL & IMPLANT SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL TIMOTHY GOCKE DDS (OWNER)
(703) 388-2805
Entity
Organization
Contact information
Practice address
7601 LEWINSVILLE RD, SUITE 203, MCLEAN, VA 22102-2814
(703) 388-2805
(703) 388-2806
Mailing address
PO BOX 1049, FAYETTEVILLE, AR 72702-1049
(479) 464-5824
(479) 725-2395
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
0401411538
VA
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
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