NPIMap

Organization Active NPI

Woodbridge Periodontal & Implant Center PLLC

  • Periodontics
  • Woodbridge, VA
National Provider Identifier
1144743709
Registry record updated Aug 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
0401414973 Issued in VA
Legal business name
WOODBRIDGE PERIODONTAL & IMPLANT CENTER PLLC
Practice address
2200 Opitz Blvd Ste 205
Woodbridge, VA 22191-3343
Phone
(703) 491-2974
NPI assigned
Jul 25, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2017

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

Authorized official

Name
Dr. Ahmad Hawasli, DDS, MSC
Title
Periodontist
Phone
(773) 629-0329

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X 0401414973 VA Primary

Addresses

Primary practice location

2200 Opitz Blvd Ste 205
Woodbridge, VA 22191-3343

Mailing address

2200 Opitz Blvd
# 205
Woodbridge, VA 22191

National Provider Directory

National Provider Directory

Locations

2200 Opitz Blvd
Ste 205
Woodbridge, VA 22191
Phone (703) 491-2974

Practitioners & affiliated clinicians

Practitioners 1

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": "1500940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501804800000",
    "number": "1144743709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 OPITZ BLVD",
            "address_2": "# 205",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "22191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 OPITZ BLVD STE 205",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221913343",
            "telephone_number": "703-491-2974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODBRIDGE PERIODONTAL & IMPLANT CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-25",
        "last_updated": "2017-08-04",
        "status": "A",
        "authorized_official_last_name": "HAWASLI",
        "authorized_official_first_name": "AHMAD",
        "authorized_official_title_or_position": "PERIODONTIST",
        "authorized_official_telephone_number": "773-629-0329",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MSC"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "VA",
            "license": "0401414973",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbridge, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2017; 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.