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Deep Roots Periodontics PLLC

Periodontics practice in Fairfax, VA

Registered specialistLicense # listed (VA)

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Public-record details

Address
11130 Fairfax Blvd, Suite 100, Fairfax, VA 22030
Phone
(954) 536-1111
Listed under
Periodontists, Specialty practices
NPI
1255695243
NPI status
Active in the NPPES registry
Provider type
Organization (practice, clinic or company)
Registered specialty (self-reported taxonomy)
Periodontics (1223P0300X)
License number on NPI record
0401-413327 (VA)
Authorized official
Taeheon Kang, DDS, MS, Periodontis
NPI first issued
Jun 25, 2012
NPI record last updated
Jun 25, 2012

NPI 1255695243 is active in the federal NPPES registry (CMS) with Periodontics, an ADA-recognized dental specialty, as its primary taxonomy; license 0401-413327 (VA) is listed on the record. Source: NPPES NPI Registry (CMS) (record). Data as of 2026-09-30.

What these registry facts mean

The NPI (National Provider Identifier) is the federal ID every HIPAA-covered provider uses to bill insurance. This NPI belongs to an organization, so it may cover several clinicians at this location. The specialty is the taxonomy the provider chose when registering; NPPES does not check it. A license number here is what the provider entered — confirm it with the state board before you rely on it. Periodontists specialize in the gums and bone that support the teeth, including placing implants, gum and bone grafting, and treating gum disease. Dentists who are not specialists can also place implants; the specialty here is the one the provider registered as primary.

View NPI 1255695243 in the official registry ↗

Checking credentials: the specialty shown is the one this provider registered with the NPI system. Your state dental board's license lookup confirms the license, and the American Board of Prosthodontics, the American Board of Oral and Maxillofacial Surgery and the American Board of Periodontology each list their board-certified members.

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