NPIMap

Organization Active NPI

Prestige Dental Specialists

Doing business as Center for Dentofacial Aesthetics

  • Dentist
  • Annandale, VA
National Provider Identifier
1073990594
Registry record updated May 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0401412751 Issued in VA
Legal business name
PRESTIGE DENTAL SPECIALISTS
Doing business as
Center for Dentofacial Aesthetics
Practice address
7630 Little River Tpke
115
Annandale, VA 22003-2610
Phone
(703) 256-2556
Fax
(703) 256-7722
NPI assigned
May 5, 2015
Last updated
May 5, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2015

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

Authorized official

Name
Dr. Norachai Phisuthikul, DDS
Title
Owner
Phone
(703) 256-2556

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 0401412751 VA Primary

Addresses

Primary practice location

7630 Little River Tpke
115
Annandale, VA 22003-2610

Mailing address

7630 Little River Tpke
115
Annandale, VA 22003-2610
Phone (703) 256-2556

Other names 1

  • Center for Dentofacial Aesthetics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Center for Dentofacial Aesthetics2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

7630 Little River Tpke
Ste 115
Annandale, VA 22003
Phone (703) 256-2556

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1430784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430784000000",
    "number": "1073990594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7630 LITTLE RIVER TPKE",
            "address_2": "115",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220032610",
            "telephone_number": "703-256-2556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7630 LITTLE RIVER TPKE",
            "address_2": "115",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220032610",
            "telephone_number": "703-256-2556",
            "fax_number": "703-256-7722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTIGE DENTAL SPECIALISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-05",
        "last_updated": "2015-05-05",
        "status": "A",
        "authorized_official_last_name": "PHISUTHIKUL",
        "authorized_official_first_name": "NORACHAI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-256-2556",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401412751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Center for Dentofacial Aesthetics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Annandale, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2015; 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.