Individual provider Active NPI

Rosemary Ahanor, DDS

  • Dentist
  • Reston, VA
National Provider Identifier
1124477765
Registry record updated Feb 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0401416406 Issued in VA
Practice address
11150 Sunset Hills Rd Ste 303
Reston, VA 20190-5335
Phone
(703) 651-6130
NPI assigned
Jun 4, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X IN PROCESS DC
Dentist 122300000X 101713 DC
Dentist 122300000X 16307 MD
Dentist 122300000X 0401416406 VA Primary

Addresses

Primary practice location

11150 Sunset Hills Rd Ste 303
Reston, VA 20190-5335

Mailing address

1100 Alabama Ave SE
Washington, DC 20032-4540
Phone (202) 299-5610

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170908000947 DC Order and Referring Only - DentistPractitioner - Dentist 0244503548

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
16307MDMDClinical Social Worker
101713DCMDDentist
IN PROCESSDCMDDentist
0401416406VAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Aglow Dental Studio CurrentSince Mar 4, 2021 Accepting new patients

Locations

11150 Sunset Hills Rd
Ste 303
Reston, VA 20190
Phone (703) 651-6130

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1464998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614038400000",
    "number": "1124477765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 ALABAMA AVE SE",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200324540",
            "telephone_number": "202-299-5610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11150 SUNSET HILLS RD STE 303",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201905335",
            "telephone_number": "703-651-6130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AHANOR",
        "first_name": "ROSEMARY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-04",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "DC",
            "license": "IN PROCESS",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "DC",
            "license": "101713",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MD",
            "license": "16307",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401416406",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reston, VA

Sources for this page

Verify at the official NPI Registry.