Premier Dental Group PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

PREMIER DENTAL GROUP PLLC

Doing business as

Lighthouse Pediatric Dental Team

Practice address

9420 Forestwood LN Ste 201
Manassas, VA 20110-4758

Phone

(617) 943-8812

NPI assigned

Mar 18, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Payam AmirsayafiNPI 1881968204

Title

Owner

Phone

(617) 943-8812

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Lighthouse Pediatric Dental Team Doing business as

Electronic endpoints 1

Practitioners 1

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

• Payam Amirsayafi

  • Pediatric Dentistry
  • Stafford, VA
  • NPI 1881968204
  NPD (past) Authorized official

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

{
    "created_epoch": "1552867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552867200000",
    "number": "1063971281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9420 FORESTWOOD LN STE 201",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201104758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9420 FORESTWOOD LN STE 201",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201104758",
            "telephone_number": "617-943-8812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER DENTAL GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-18",
        "last_updated": "2019-03-18",
        "status": "A",
        "authorized_official_last_name": "AMIRSAYAFI",
        "authorized_official_first_name": "PAYAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-943-8812",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223D0004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Dental Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881968204",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "info@lighthousepdteam.com",
            "affiliation": "N",
            "endpointDescription": "office email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "9420 Forestwood Ln Ste 201",
            "city": "Manassas",
            "state": "VA",
            "country_code": "US",
            "postal_code": "201104758",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Lighthouse Pediatric Dental Team",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nichole Poyser
• Vikram Prasanna, M.D.
• Katie Pratt
• Amy Prechel, OTR/L
• Premier Allergy and Asthma Centers, LLC
• Premier Healthcare Group LLC
• Premise Health of Connecticut Medical, P.C. (MTV Health Center)
• Premise Health of Virginia Medical PC (The Wellness Center Operated by Premise Health)
• Premise Health of Virginia Medical PC (Novec - Manassas)
• Premise Health of Virginia Medical, P.C (BAE Systems Manassas VA)

• Pediatric Dentistry in Manassas, VA
• Providers in Manassas, VA by specialty
• Pediatric Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2019; 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.