Lake Ridge Endodontics

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

041007464 Issued in VA

Legal business name

LAKE RIDGE ENDODONTICS

Practice address

12510 C Lake Ridge Dr
Woodbridge, VA 22192-2335

Phone

(703) 494-8624

Fax

(703) 497-1258

NPI assigned

Sep 20, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Todd E Wynkoop, DDS MSNPI 1265446561

Title

Owner/Endodotontist

Phone

(703) 494-8624

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Todd E Wynkoop, DDS

  • Endodontics
  • Woodbridge, VA
  • NPI 1265446561
  NPD (past) Authorized official

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215561600000",
    "number": "1205933405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12510 LAKE RIDGE DR STE C",
            "city": "LAKE RIDGE",
            "state": "VA",
            "postal_code": "221927501",
            "telephone_number": "703-494-8624",
            "fax_number": "703-497-1258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12510 C LAKE RIDGE DR",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221922335",
            "telephone_number": "703-494-8624",
            "fax_number": "703-497-1258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE RIDGE ENDODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2008-07-09",
        "status": "A",
        "authorized_official_last_name": "WYNKOOP",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER/ENDODOTONTIST",
        "authorized_official_telephone_number": "703-494-8624",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS MS"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": "VA",
            "license": "041007464",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "872859",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "174982",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laboratory Corporation of America
• Paula A Labriola, M.D.
• Lake Ridge Ambulatory Surgery Center, LLC
• Lake Ridge Anesthesia LLC
• Lake Ridge Dental Care
• Lake Ridge Internal Medicne, PC
• Lake Ridge Ophthalmology LLC
• Lake Ridge Orthodontics PC
• Lake Ridge Pediatric Dentistry PLLC
• Lake Ridge Physical Therapy, LLC

• Endodontics in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Endodontics in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.