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Deactivated NPI 1770653495 Deactivated / Inactive NPI Male Practitioner

Dr. Gary Ellenbogen , DDS

Dentist - General Practice • Vienna, VA

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Gary Ellenbogen has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date November 09, 2006
NPI Deactivation Date April 28, 2010
Total Practice Duration ~4 Years of Practice (2006 – 2010)

Professional Overview & Biography Verified Profile Summary

Dr. Gary Ellenbogen, DDS was a registered Dentist - General Practice practicing in Vienna, VA. Throughout an active medical career spanning 4 years, Dr. Ellenbogen provided care at the practice location at 8100 BOONE BLVD until profile deactivation on 2010-04-28.

Practice Location & Contact Primary Location

Practice Address

8100 Boone Blvd

Vienna, VA 221822665

Telephone 7037341095
Fax 7037149330
Associated Practice Facility / Clinic
🏢 Dental Associates Facility NPI 1700905635

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Vienna, VA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 14.6 Yrs
Regional Practice Density
61 Specialists

Practicing in Vienna, VA (3535 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License VA 5562

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
Robert Legonitte , DDO

Dentist - General Practice

NPI 1194899229

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Reactivated September 11, 2013

Record officially reactivated for active practice on September 11, 2013

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Updated Practice Location September 11, 2013

Registered at 8100 BOONE BLVD, VIENNA, VA 221822665 (Tel: 7037341095)

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Updated Business Mailing Address September 11, 2013

Registered at 8100 BOONE BLVD, VIENNA, VA 221822665 (Tel: 7037341095)

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Provider Name / Credentials Updated September 11, 2013

Recorded as GARY ELLENBOGEN, D.D.S.

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Medical Taxonomy / Specialty Registered (Primary Specialty) September 11, 2013

Dentist (License #5562 in VA)

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NPI Profile Deactivated April 28, 2010

Record deactivated on April 28, 2010

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Initial NPI Registration & Enumeration November 09, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1770653495
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: November 09, 2006
Last Update: September 11, 2013
Deactivation Date: April 28, 2010
Sole Proprietor: No

Mailing Address

8100 Boone Blvd

Vienna, VA 221822665

Phone: 7037341095

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.