NPIMap

Organization Active NPI

Dental Professionals of Virginia, P.C

  • General Practice Dentistry
  • Broadlands, VA
National Provider Identifier
1104253186
Registry record updated Jan 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DENTAL PROFESSIONALS OF VIRGINIA, P.C
Practice address
43170 Southern Walk PLZ
Suite 116
Broadlands, VA 20148-4464
Phone
(703) 957-7066
NPI assigned
Oct 4, 2013
Organization subpart
Yes
Parent organization
DENTAL PROFESSIONALS OF VIRGINIA, P.CAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 11, 2014

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

Authorized official

Name
Lindsay Bearden
Title
Insurane/Credentialing
Phone
(217) 540-5100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

43170 Southern Walk PLZ
Suite 116
Broadlands, VA 20148-4464

Mailing address

43170 Southern Walk PLZ
Suite 116
Broadlands, VA 20148-4464
Phone (703) 957-7066

Other names 1

  • Broadlands Complete Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental Professionals of Virginia PC69 organizations share this tax ID, including this one
Part of
Dental Professionals of Virginia PC

Organizations with this tax ID in the same state 17

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 17

Locations

43170 Southern Walk Plz
Ste 116
Broadlands, VA 20148
Phone (703) 687-4320

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1380844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389398400000",
    "number": "1104253186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43170 SOUTHERN WALK PLZ",
            "address_2": "SUITE 116",
            "city": "BROADLANDS",
            "state": "VA",
            "postal_code": "201484464",
            "telephone_number": "703-957-7066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43170 SOUTHERN WALK PLZ",
            "address_2": "SUITE 116",
            "city": "BROADLANDS",
            "state": "VA",
            "postal_code": "201484464",
            "telephone_number": "703-957-7066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PROFESSIONALS OF VIRGINIA, P.C",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL PROFESSIONALS OF VIRGINIA, P.C",
        "enumeration_date": "2013-10-04",
        "last_updated": "2014-01-11",
        "status": "A",
        "authorized_official_last_name": "BEARDEN",
        "authorized_official_first_name": "LINDSAY",
        "authorized_official_title_or_position": "INSURANE/CREDENTIALING",
        "authorized_official_telephone_number": "217-540-5100"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Broadlands Complete Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Broadlands, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2014; 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.