NPIMap

Organization Active NPI

Chantilly Modern Dentistry, PC

  • Dentist
  • Chantilly, VA
National Provider Identifier
1013405950
Registry record updated Aug 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
CHANTILLY MODERN DENTISTRY, PC
Practice address
14337 Newbrook Dr.
Suite 200
Chantilly, VA 20151
Phone
(703) 214-2113
NPI assigned
Apr 26, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2022

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

Authorized official

Name
Dr. Alex R Sharifian, DDS
Title
Owner/DDS
Phone
(703) 214-2113

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

14337 Newbrook Dr.
Suite 200
Chantilly, VA 20151

Mailing address

PO Box 920050
Dallas, TX 75392-0050
Phone (714) 845-8280

Other names 1

  • Chantilly Modern Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

14337 Newbrook Dr
Ste 200
Chantilly, VA 20151
Phone (703) 214-2113

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1524700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659657600000",
    "number": "1013405950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050",
            "telephone_number": "714-845-8280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14337 NEWBROOK DR.",
            "address_2": "SUITE 200",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "20151",
            "telephone_number": "703-214-2113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANTILLY MODERN DENTISTRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-26",
        "last_updated": "2022-08-05",
        "certification_date": "2022-08-05",
        "status": "A",
        "authorized_official_last_name": "SHARIFIAN",
        "authorized_official_first_name": "ALEX",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER/DDS",
        "authorized_official_telephone_number": "703-214-2113",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chantilly Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chantilly, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2022; 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.