Active NPI
Reza Fardshisheh, DMD
- Endodontics
- Springfield, VA
National Provider Identifier
1023213758
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 0401411770
- Practice address
- 6120 Brandon Ave Ste 314
Springfield, VA 22150-2504 - Phone
- (703) 569-0002
- Fax
- (703) 569-8758
- NPI assigned
- Jun 21, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 0401411770 | VA | Primary |
Addresses
Primary practice location
6120 Brandon Ave Ste 314
Springfield, VA 22150-2504
Mailing address
11359 Sunset Hills Rd
Reston, VA 20190-5275
Phone (703) 437-6666
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401411770 | VA | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182384000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023213758",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11359 SUNSET HILLS RD",
"city": "RESTON",
"state": "VA",
"postal_code": "201905275",
"telephone_number": "703-437-6666",
"fax_number": "703-435-8281"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6120 BRANDON AVE STE 314",
"city": "SPRINGFIELD",
"state": "VA",
"postal_code": "221502504",
"telephone_number": "703-569-0002",
"fax_number": "703-569-8758"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FARDSHISHEH",
"first_name": "REZA",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "VA",
"license": "0401411770",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, VA
Sources for this page
- 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.