Todd E Wynkoop, DDS

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

0401007464 Issued in VA

Practice address

12510 Lake Ridge Dr Ste C
Woodbridge, VA 22192-7501

Phone

(703) 494-8624

Fax

(703) 497-1258

NPI assigned

Jul 29, 2006

Last updated

Jul 15, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Aug 31, 2015 through Aug 31, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lake Ridge Endodontics

  • Endodontics
  • Woodbridge, VA
  • NPI 1205933405
  NPD (past) Authorized official

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216080000000",
    "number": "1265446561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12510 LAKE RIDGE DR STE C",
            "city": "WOODBRIDGE",
            "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 LAKE RIDGE DR STE C",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221927501",
            "telephone_number": "703-494-8624",
            "fax_number": "703-497-1258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNKOOP",
        "first_name": "TODD",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-29",
        "last_updated": "2008-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "VA",
            "license": "0401007464",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0401007464",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "872859",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• WSSH Powerback Rehabilitation Services, LLC
• Richard Wyatt, LPC, CSOTP
• Elizabeth Sue Wyman, LPC
• Mary Jane Wyman, M.D.
• Olga Vladimirovna Wymore
• Alan Howard Wynn, M.D.
• Andrew Ross Wynn, LCSW
• Erica Larae Wynn, M.D.
• Lisa Xantus, LPC
• Duo Xu, APRN

• 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 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.