NPIMap

Organization Active NPI

Marybeth Fasano DMD PC

  • Dental Clinic/Center
  • Virginia Beach, VA
National Provider Identifier
1194905539
Registry record updated Nov 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
0401008908 Issued in VA
Legal business name
MARYBETH FASANO DMD PC
Practice address
984 First Colonial Rd
Suite 200
Virginia Beach, VA 23454-3196
Phone
(757) 412-2235
Fax
(757) 412-2237
NPI assigned
Nov 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2007

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

Authorized official

Name
Ms. Shana D Randolph
Title
Insurance/Financial Coordinator
Phone
(757) 412-2235

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 0401008908 VA Primary

Addresses

Primary practice location

984 First Colonial Rd
Suite 200
Virginia Beach, VA 23454-3196

Mailing address

984 First Colonial Rd
Suite 200
Virginia Beach, VA 23454-3196
Phone (757) 412-2235

Other identifiers 2

IdentifierTypeStateIssuer
980759OtherVAUNITED CONCORDIA
153899OtherVAANTHEM

National Provider Directory

National Provider Directory

Locations

984 First Colonial Rd
Ste 200
Virginia Beach, VA 23454
Phone (757) 412-2235

Practitioners & affiliated clinicians

Practitioners 2

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": "1194912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194912000000",
    "number": "1194905539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "984 FIRST COLONIAL RD",
            "address_2": "SUITE 200",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234543196",
            "telephone_number": "757-412-2235",
            "fax_number": "757-412-2237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "984 FIRST COLONIAL RD",
            "address_2": "SUITE 200",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234543196",
            "telephone_number": "757-412-2235",
            "fax_number": "757-412-2237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYBETH FASANO DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-13",
        "last_updated": "2007-11-13",
        "status": "A",
        "authorized_official_last_name": "RANDOLPH",
        "authorized_official_first_name": "SHANA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "INSURANCE/FINANCIAL COORDINATOR",
        "authorized_official_telephone_number": "757-412-2235",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "VA",
            "license": "0401008908",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "980759",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "153899",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2007; 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.