Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.

Legacy Dental Implant of Herndon

Organization Periodontics · NPI 1053201384

Legacy Dental Implant of Herndon provides 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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