Active NPI
Conchetta Vinson Brevard, RDH
- Dental Hygienist
- Ft Belvoir, VA
National Provider Identifier
1144884529
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 0402206416
- Practice address
- 9300 Dewitt Loop
Ft Belvoir, VA 22060-5285 - Phone
- (571) 231-3531
- NPI assigned
- Apr 30, 2019
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 0402206416 | VA | Primary |
Addresses
Primary practice location
9300 Dewitt Loop
Ft Belvoir, VA 22060-5285
Mailing address
120 Short Branch Rd
Stafford, VA 22556-4642
Phone (571) 599-9396
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0402206416 | VA | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1556582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1556582400000",
"number": "1144884529",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 SHORT BRANCH RD",
"city": "STAFFORD",
"state": "VA",
"postal_code": "225564642",
"telephone_number": "571-599-9396"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9300 DEWITT LOOP",
"city": "FT BELVOIR",
"state": "VA",
"postal_code": "220605285",
"telephone_number": "571-231-3531"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BREVARD",
"first_name": "CONCHETTA",
"middle_name": "VINSON",
"credential": "RDH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-30",
"last_updated": "2019-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "VA",
"license": "0402206416",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ft Belvoir, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.