NPIMap

Organization Active NPI

Dental Professionals of Virginia, P.C

Doing business as Little Bull Run Dental

  • General Practice Dentistry
  • Gainesville, VA
National Provider Identifier
1346770682
Registry record updated Jun 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DENTAL PROFESSIONALS OF VIRGINIA, P.C
Doing business as
Little Bull Run Dental
Practice address
13801 Heathcote Blvd
Ste 100
Gainesville, VA 20155
Phone
(571) 222-6042
NPI assigned
Jun 19, 2017
Last updated
Jun 19, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
DENTAL PROFESSIONALS OF VIRGINIA, P.CAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 19, 2017

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

Authorized official

Name
Kendra Walker
Title
Credentialing Supervisor
Phone
(217) 540-8312

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

13801 Heathcote Blvd
Ste 100
Gainesville, VA 20155

Mailing address

13801 Heathcote Blvd
Ste 100
Gainesville, VA 20155

Other names 1

  • Little Bull Run Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Miller DDS PC69 organizations share this tax ID, including this one
Part of
Miller DDS PC

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

13801 Heathcote Blvd
Ste 100
Gainesville, VA 20155
Phone (571) 222-6042

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1497830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497830400000",
    "number": "1346770682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13801 HEATHCOTE BLVD",
            "address_2": "STE 100",
            "city": "GAINESVILLE",
            "state": "VA",
            "postal_code": "20155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13801 HEATHCOTE BLVD",
            "address_2": "STE 100",
            "city": "GAINESVILLE",
            "state": "VA",
            "postal_code": "20155",
            "telephone_number": "571-222-6042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PROFESSIONALS OF VIRGINIA, P.C",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL PROFESSIONALS OF VIRGINIA, P.C",
        "enumeration_date": "2017-06-19",
        "last_updated": "2017-06-19",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "KENDRA",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "217-540-8312"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Little Bull Run Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Little Bull Run Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gainesville, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 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.