Individual provider Active NPI

Faranak Khasraghi, D.D.S., D.M.D

  • General Practice Dentistry
  • Woodbridge, VA
National Provider Identifier
1194817296
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
0401410761 Issued in VA
Practice address
4008 Genesee PL
Suite 205
Woodbridge, VA 22192-8306
Phone
(703) 670-4888
Fax
(703) 670-6602
NPI assigned
Sep 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 0401410761 VA Primary

Addresses

Primary practice location

4008 Genesee PL
Suite 205
Woodbridge, VA 22192-8306

Mailing address

4008 Genesee PL
Suite 205
Woodbridge, VA 22192-8306
Phone (703) 670-4888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20161121001556 VA Order and Referring Only - DentistPractitioner - Dentist 8527346360

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0401410761VAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
County Center Dental PLLC General Practice Past Accepting new patients

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": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1194817296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4008 GENESEE PL",
            "address_2": "SUITE 205",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221928306",
            "telephone_number": "703-670-4888",
            "fax_number": "703-670-6602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4008 GENESEE PL",
            "address_2": "SUITE 205",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221928306",
            "telephone_number": "703-670-4888",
            "fax_number": "703-670-6602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHASRAGHI",
        "first_name": "FARANAK",
        "credential": "D.D.S., D.M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401410761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbridge, VA

Sources for this page

Verify at the official NPI Registry.