NPIMap

Organization Active NPI

Dental Professionals of Virginia, P.C.

Doing business as Blue Mountain Dental Care

  • General Practice Dentistry
  • Winchester, VA
National Provider Identifier
1417675109
Registry record updated Dec 10, 2024
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
Blue Mountain Dental Care
Practice address
615 E Jubal Early Dr
Winchester, VA 22601-5178
Phone
(540) 360-1100
NPI assigned
Aug 18, 2022
Last updated
Dec 10, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
DENTAL PROFESSIONALS OF VIRGINIA, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 10, 2024

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

Authorized official

Name
Hillary Thull
Title
Credentialing Coordinator
Phone
(217) 540-8946

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

615 E Jubal Early Dr
Winchester, VA 22601-5178

Mailing address

615 E Jubal Early Dr
Winchester, VA 22601-5178

Other names 1

  • Blue Mountain Dental Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Heartland Dental Care of Virginia PC69 organizations share this tax ID, including this one
Part of
Heartland Dental Care of Virginia 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

615 E Jubal Early Dr
Winchester, VA 22601
Phone (540) 360-1100

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 2

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": "1660780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733788800000",
    "number": "1417675109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 E JUBAL EARLY DR",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "226015178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 E JUBAL EARLY DR",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "226015178",
            "telephone_number": "540-360-1100"
        }
    ],
    "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": "2022-08-18",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A",
        "authorized_official_last_name": "THULL",
        "authorized_official_first_name": "HILLARY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-8946"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Mountain Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winchester, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2024; 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.