NPIMap

Organization Active NPI

SSD - Stafford PLLC

Doing business as Stafford Smile Design

  • General Practice Dentistry
  • Stafford, VA
National Provider Identifier
1376349803
Registry record updated Feb 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
SSD - STAFFORD PLLC
Doing business as
Stafford Smile Design
Practice address
12 Pga Dr
Suite 201
Stafford, VA 22554
Phone
(540) 720-2627
NPI assigned
Feb 24, 2025
Last updated
Feb 24, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2025

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

Authorized official

Name
Chad Hendricks
Title
Credentialing
Phone
(612) 859-0444

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

12 Pga Dr
Suite 201
Stafford, VA 22554

Mailing address

12 Pga Dr
Suite 201
Stafford, VA 22554
Phone (540) 720-2627

Other names 1

  • Stafford Smile Design Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1740355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740355200000",
    "number": "1376349803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 PGA DR",
            "address_2": "SUITE 201",
            "city": "STAFFORD",
            "state": "VA",
            "postal_code": "22554",
            "telephone_number": "540-720-2627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 PGA DR",
            "address_2": "SUITE 201",
            "city": "STAFFORD",
            "state": "VA",
            "postal_code": "22554",
            "telephone_number": "540-720-2627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSD - STAFFORD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-24",
        "last_updated": "2025-02-24",
        "certification_date": "2025-02-24",
        "status": "A",
        "authorized_official_last_name": "HENDRICKS",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "612-859-0444"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stafford Smile Design",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Stafford Smile Design",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stafford, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2025; 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.