Stephane Tisseront, DDS, MS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

0401008928 Issued in VA

Practice address

11720 Plaza America Dr
Suite 110
Reston, VA 20190-4757

Phone

(703) 773-1200

Fax

(703) 773-1201

NPI assigned

Aug 27, 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

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1188172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1188345600000",
    "number": "1013100601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11720 PLAZA AMERICA DR",
            "address_2": "SUITE 110",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201904757",
            "telephone_number": "703-773-1200",
            "fax_number": "703-773-1201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11720 PLAZA AMERICA DR",
            "address_2": "SUITE 110",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201904757",
            "telephone_number": "703-773-1200",
            "fax_number": "703-773-1201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TISSERONT",
        "first_name": "STEPHANE",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-27",
        "last_updated": "2007-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "VA",
            "license": "0401008928",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Susan Thuma, ATC
• Candace S. Thurston, M.D.
• Marissa G Tibbetts, DPT
• Emma Maria Tierney
• Susan Hanley Tilton, MD
• Charles Cameron Titus, MD
• Mingliarti Tjahjana, M.D.
• TLC the Laser Center (Northeast) Inc.
• Jamieson Tobey, LPTA
• Lindsay R Tom, PA

• Orthodontics and Dentofacial Orthopedics Dentistry in Reston, VA
• Providers in Reston, VA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 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.