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

Legacy Dental Implant of Herndon

Organization Periodontics · NPI 1053201384

Legacy Dental Implant of Herndon is a Periodontics in Herndon, Virginia. Registered with an NPI since 2025.

In the registry since
2025

Practice location Address checks out

208 Elden St
Herndon, VA 20170-4877
Phone: (646) 824-3829
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Periodontics (primary) Taxonomy 1223P0300X

Record details

NPI number1053201384
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Abdelrouf Suwid — Owner · (646) 824-3829
NPI enumeratedJuly 8, 2025
Last updated in NPPESJuly 8, 2025
Certification dateJuly 8, 2025
Mailing address208 Elden St, Herndon, VA 20170-4877

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