Ricardo Sixto Gaitan, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401418095 Issued in VA

Practice address

8301 Arlington Blvd Ste 403
Fairfax, VA 22031-2902

Phone

(703) 206-0466

NPI assigned

Aug 15, 2022

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Boulevard Dental Clinic

  • Dental Clinic/Center
  • Fairfax, VA
  • NPI 1639346182
  NPD (past)

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

{
    "created_epoch": "1660521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660521600000",
    "number": "1053039248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6452 LAKE MEADOW DR",
            "city": "BURKE",
            "state": "VA",
            "postal_code": "220153927",
            "telephone_number": "703-405-5618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8301 ARLINGTON BLVD STE 403",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220312902",
            "telephone_number": "703-206-0466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAITAN",
        "first_name": "RICARDO",
        "middle_name": "SIXTO",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-15",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401418095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dale R. Gadue, RN
• Stephen Andrew Gaeta, M.D., PH.D.
• Iljana Marjorie Gaffar, M.D.
• Kathleen Anne Gahl, MS
• Vilma Gisell Gaitan Valdizan, LCSW, CSAC
• Shayla Kristin Gaither, M.D.
• Matthew Frank Galati, D.V.M.
• Nicholas Galea, EDS, NCSP
• Frank Martin Galioto Jr., M.D.
• Erin Elizabeth Gallagher, MSW

• General Practice Dentistry in Fairfax, VA
• Providers in Fairfax, 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 Aug 15, 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.