NPIMap

Organization Active NPI

Manassas Modern Dentistry PLLC

  • Dentist
  • Manassas, VA
National Provider Identifier
1114652286
Registry record updated May 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
MANASSAS MODERN DENTISTRY PLLC
Practice address
10620 Crestwood Dr Ste a
Manassas, VA 20109-4403
Phone
(703) 361-2911
NPI assigned
Jul 21, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2023

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

Authorized official

Name
Dr. Tareq Salameh, DDSNPI 1477724920
Title
Doctor/Owner
Phone
(561) 827-1164

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

10620 Crestwood Dr Ste a
Manassas, VA 20109-4403

Mailing address

10620 Crestwood Dr Ste a
Manassas, VA 20109-4403
Phone (703) 361-2911

Other names 1

  • Manassas Modern Dentistry PLLC Doing business as

National Provider Directory

National Provider Directory

Locations

10620 Crestwood Dr
Ste A
Manassas, VA 20109
Phone (561) 827-1164

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1658361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683763200000",
    "number": "1114652286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10620 CRESTWOOD DR STE A",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201094403",
            "telephone_number": "703-361-2911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10620 CRESTWOOD DR STE A",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201094403",
            "telephone_number": "703-361-2911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANASSAS MODERN DENTISTRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-21",
        "last_updated": "2023-05-11",
        "certification_date": "2023-05-11",
        "status": "A",
        "authorized_official_last_name": "SALAMEH",
        "authorized_official_first_name": "TAREQ",
        "authorized_official_title_or_position": "DOCTOR/OWNER",
        "authorized_official_telephone_number": "561-827-1164",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Manassas Modern Dentistry PLLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Manassas Modern Dentistry PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Manassas, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2023; 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.