NPIMap

Organization Active NPI

Ideal Endodontics of Woodbridge PLLC

  • Endodontics
  • Woodbridge, VA
National Provider Identifier
1205307238
Registry record updated Dec 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
Legal business name
IDEAL ENDODONTICS OF WOODBRIDGE PLLC
Practice address
3102 Golansky Blvd Ste 101
Woodbridge, VA 22192-4244
Phone
(571) 991-3700
NPI assigned
Dec 17, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2018

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

Authorized official

Name
Moein Jabbar Darjani, DDSNPI 1508147190
Title
Owner
Phone
(310) 402-4038

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
EndodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223E0200X Primary

Addresses

Primary practice location

3102 Golansky Blvd Ste 101
Woodbridge, VA 22192-4244

Mailing address

3102 Golansky Blvd Ste 101
Woodbridge, VA 22192-4244

National Provider Directory

National Provider Directory

Locations

3102 Golansky Blvd
Ste 101
Woodbridge, VA 22192
Phone (571) 444-8977

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": "1545004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545004800000",
    "number": "1205307238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3102 GOLANSKY BLVD STE 101",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221924244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3102 GOLANSKY BLVD STE 101",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221924244",
            "telephone_number": "571-991-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEAL ENDODONTICS OF WOODBRIDGE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-17",
        "last_updated": "2018-12-17",
        "status": "A",
        "authorized_official_last_name": "JABBAR DARJANI",
        "authorized_official_first_name": "MOEIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-402-4038",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbridge, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2018; 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.