Active NPI
Rosemary Ahanor, DDS
- Dentist
- Reston, VA
National Provider Identifier
1124477765
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 0401416406
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170908000947 | DC | Order and Referring Only - Dentist | 0244503548 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16307 | MD | MD | Clinical Social Worker |
| 101713 | DC | MD | Dentist |
| IN PROCESS | DC | MD | Dentist |
| 0401416406 | VA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aglow Dental Studio | Current | 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.
-
- Dental Clinic/Center
- Reston, VA
- NPI 1295374734
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.