Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Deep Roots Periodontics PLLC

Organization Periodontics · NPI 1255695243

Deep Roots Periodontics PLLC is a Periodontics in Fairfax, Virginia. Licensed in Virginia. Registered with an NPI since 2012.

Licensed in
VA
In the registry since
2012
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

11130 Fairfax Blvd Ste 100
Fairfax, VA 22030-5035
Phone: (954) 536-1111
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Periodontics (primary) Taxonomy 1223P0300X · Licence 0401-413327 (VA)

Record details

NPI number1255695243
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Taeheon Kang — Periodontis · (954) 536-1111
NPI enumeratedJune 25, 2012
Last updated in NPPESJune 25, 2012
Mailing address11130 Fairfax Blvd, Suite 100, Fairfax, VA 22030-5035

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