Dental One Associates (Woodson Square), LTD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DENTAL ONE ASSOCIATES (WOODSON SQUARE), LTD

Practice address

9661 Main St
Suite C
Fairfax, VA 22031-3757

Phone

(703) 425-3737

Fax

(703) 425-3762

NPI assigned

May 4, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Stephanie Gomez

Title

Credentialing Supervisor

Phone

(305) 274-2499

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501545600000",
    "number": "1205048972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9661 MAIN ST",
            "address_2": "SUITE C",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220313757",
            "telephone_number": "703-425-3737",
            "fax_number": "703-425-3762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9661 MAIN ST",
            "address_2": "SUITE C",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220313757",
            "telephone_number": "703-425-3737",
            "fax_number": "703-425-3762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL ONE ASSOCIATES (WOODSON SQUARE), LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2017-08-01",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "305-274-2499",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Denny
• Dental Associates
• Dental Associates LTD
• Dental Associates of Northern Virginia PLLC
• Dental One Associates (Old Dominion) PLLC
• Dental Professionals of Virginia, P.C.
• Dental Services DDS, PC
• Dentists of Fair Oaks
• Deborah Ruth Deperio
• Andrew John Itutud Derks, PHYSICIAN ASSISTANT

• General Practice Dentistry in Fairfax, VA
• Providers in Fairfax, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 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.