NPIMap

Organization Active NPI

Mitnick & Herbst, PC

  • Pediatric Dentistry
  • Sterling, VA
National Provider Identifier
1417245481
Registry record updated Jul 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
5876 Issued in VA
Legal business name
MITNICK & HERBST, PC
Practice address
21475 Ridgetop Cir
200
Sterling, VA 20166-6580
Phone
(703) 444-3710
Fax
(703) 444-8607
NPI assigned
Jul 12, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2011

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

Authorized official

Name
Ms. Valerie Kamman
Title
Office Manager
Phone
(703) 444-3710

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 6232 VA
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 5876 VA Primary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 0184 VA

Addresses

Primary practice location

21475 Ridgetop Cir
200
Sterling, VA 20166-6580

Mailing address

21475 Ridgetop Cir
200
Sterling, VA 20166-6580
Phone (703) 444-3710

Other identifiers 2

IdentifierTypeStateIssuer
0008375MedicaidVA
0012899MedicaidVA

National Provider Directory

National Provider Directory

Locations

21475 Ridgetop Cir
Ste 200
Sterling, VA 20166
Phone (703) 444-3710

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1310428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310428800000",
    "number": "1417245481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21475 RIDGETOP CIR",
            "address_2": "200",
            "city": "STERLING",
            "state": "VA",
            "postal_code": "201666580",
            "telephone_number": "703-444-3710",
            "fax_number": "703-444-8607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21475 RIDGETOP CIR",
            "address_2": "200",
            "city": "STERLING",
            "state": "VA",
            "postal_code": "201666580",
            "telephone_number": "703-444-3710",
            "fax_number": "703-444-8607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MITNICK & HERBST, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-12",
        "last_updated": "2011-07-12",
        "status": "A",
        "authorized_official_last_name": "KAMMAN",
        "authorized_official_first_name": "VALERIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "703-444-3710",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "6232",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "VA",
            "license": "5876",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "VA",
            "license": "0184",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0008375",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0012899",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sterling, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2011; 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.