Organization
GOOSE CREEK VILLAGE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL H KIM DDS (DENTIST / PARTNER)
(703) 723-4224
Entity
Organization
Contact information
Practice address
21001 SYCOLIN RD, SUITE 240, ASHBURN, VA 20147-4073
(703) 723-4224
(703) 723-4220
Mailing address
21001 SYCOLIN RD, SUITE 240, ASHBURN, VA 20147-4073
(703) 723-4224
(703) 723-4220
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
0401413573
VA
Other
Enumeration date
09/05/2014
Last updated
09/05/2014
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