NPIMap

Organization Active NPI

Woodside Pediatric Dentistry

  • Pediatric Dentistry
  • Warrenton, VA
National Provider Identifier
1154467249
Registry record updated Jun 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
0401411006 Issued in VA
Legal business name
WOODSIDE PEDIATRIC DENTISTRY
Practice address
400 Holiday CT
Suite 107
Warrenton, VA 20186-4349
Phone
(540) 341-0014
Fax
(540) 341-0303
NPI assigned
Jan 29, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2008

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

Authorized official

Name
Jennifer L. WoodsideNPI 1184790891
Title
Dentist
Phone
(540) 341-0014

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
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 0401411006 VA Primary

Addresses

Primary practice location

400 Holiday CT
Suite 107
Warrenton, VA 20186-4349

Mailing address

400 Holiday CT
Suite 107
Warrenton, VA 20186-4349
Phone (540) 341-0014

Other identifiers 3

IdentifierTypeStateIssuer
1777507OtherVAUNITED CONCORDIA
186781OtherVAANTHEM DENTAL
107966MedicaidVA

National Provider Directory

National Provider Directory

Locations

400 Holiday Ct
Ste 107
Warrenton, VA 20186
Phone (540) 341-0014

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": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213574400000",
    "number": "1154467249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 HOLIDAY CT",
            "address_2": "SUITE 107",
            "city": "WARRENTON",
            "state": "VA",
            "postal_code": "201864349",
            "telephone_number": "540-341-0014",
            "fax_number": "540-341-0303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 HOLIDAY CT",
            "address_2": "SUITE 107",
            "city": "WARRENTON",
            "state": "VA",
            "postal_code": "201864349",
            "telephone_number": "540-341-0014",
            "fax_number": "540-341-0303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODSIDE PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2008-06-16",
        "status": "A",
        "authorized_official_last_name": "WOODSIDE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "540-341-0014"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "VA",
            "license": "0401411006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1777507",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM DENTAL",
            "identifier": "186781",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107966",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Warrenton, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2008; 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.