Olmedo Ivan Villavicencio, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401007760 Issued in VA

Practice address

7501 Little River Tpke Ste 105
Annandale, VA 22003-2923

Phone

(703) 354-2878

Fax

(703) 354-2712

NPI assigned

Feb 13, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Networks

• TN PPO C-SNP
• KY PPO C-SNP

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013059450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7501 LITTLE RIVER TPKE STE 105",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220032923",
            "telephone_number": "703-354-2878",
            "fax_number": "703-354-2712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7501 LITTLE RIVER TPKE STE 105",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220032923",
            "telephone_number": "703-354-2878",
            "fax_number": "703-354-2712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VILLAVICENCIO",
        "first_name": "OLMEDO",
        "middle_name": "IVAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401007760",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Srikrishna Vemana, M.D.
• Benjamin Robert Vena, CNMT, RT(N)
• Raymond Vergne, M.D.
• Viana Healthcare Services Inc
• Luisa Villatoro Benitez, DNP, FNP-BC
• Rubeena Vincent, FNP-C
• Virginia CVS Pharmacy, L.L.C. (CVS Pharmacy #01383)
• Virginia Health Center (national rehabilitation srrvices)
• Virginia Healthcare Home Services
• Virginia Healthcare Services Hospice Care LLC (Virginia Healthcare Services)

• General Practice Dentistry in Annandale, VA
• Providers in Annandale, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.