Provider Demographics
NPI:1891136388
Name:ROLIN S HENRY, DDS,PLLC
Entity type:Organization
Organization Name:ROLIN S HENRY, DDS,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-296-2023
Mailing Address - Street 1:2112 F ST NW
Mailing Address - Street 2:SUITE #304
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-2715
Mailing Address - Country:US
Mailing Address - Phone:202-296-2023
Mailing Address - Fax:202-296-2035
Practice Address - Street 1:2112 F ST NW
Practice Address - Street 2:SUITE #304
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2715
Practice Address - Country:US
Practice Address - Phone:202-296-2023
Practice Address - Fax:202-296-2035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10000381223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0017156Medicaid