Gino Oscar Valdivieso, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401413864 Issued in VA

Practice address

7806 Centreville Rd
Manassas, VA 20111-2231

Phone

(703) 368-1166

Fax

(703) 331-0356

NPI assigned

May 12, 2013

Reactivated

Jul 19, 2019

Last updated

Jul 19, 2019By 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

Medicare fee-for-service enrollment

Enrolled in VA

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.

Enrollment records 1

Medicare enrollment (NPD)

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.

• Gino VC, DDS, PLLC

  dba Dulles Life Smiles

  • Dental Clinic/Center
  • Ashburn, VA
  • NPI 1932760196
  NPD
• MP Dental Associates DDS PC

  dba Partovi DDS PC

  • General Practice Dentistry
  • Manassas, VA
  • NPI 1205058880
  NPD (past)

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

{
    "created_epoch": "1368316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563494400000",
    "number": "1326484825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7806 CENTREVILLE RD",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201112231",
            "telephone_number": "703-368-1166",
            "fax_number": "703-331-0356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7806 CENTREVILLE RD",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201112231",
            "telephone_number": "703-368-1166",
            "fax_number": "703-331-0356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALDIVIESO",
        "first_name": "GINO",
        "middle_name": "OSCAR",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-05-12",
        "last_updated": "2019-07-19",
        "deactivation_date": "2019-06-27",
        "reactivation_date": "2019-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401413864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Uva Prince William Medical Center (UVA Health Prince William Medical Center)
• Uva Prince William Medical Center (UVA Health Prince William Medical Center)
• Uva Prince William Medical Center (UVA Health Haymarket Medical Center)
• Gayatri Vaddadi, MD
• Melinda M Vaikasiene, PT
• Michelle Eloisa Valle
• Valley Health Clinic Inc
• Valley Primary & Behavioral Health Clinic LLC
• Katherine Valliere, LPC
• Arunan Vamadevan, M.D.

• General Practice Dentistry in Manassas, VA
• Providers in Manassas, 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 Jul 19, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.