TJB of Dulles, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

0401007652 Issued in VA

Legal business name

TJB OF DULLES, LLC

Practice address

24565 Dulles Landing Dr
Suite 190
Dulles, VA 20166-2612

Phone

(703) 468-0188

Fax

(703) 754-1694

NPI assigned

Sep 22, 2015

Organization subpart

No

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

Authorized official

Name

Kerri Nichols

Title

Regional Director

Phone

(540) 494-8776

Specialties & licenses 2

Addresses

Other names 1

• Loudoun Dental Associates & Smilez Pediatric Dental Group Doing business as

Locations

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

{
    "created_epoch": "1442880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442880000000",
    "number": "1457720302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24565 DULLES LANDING DR",
            "address_2": "SUITE 190",
            "city": "DULLES",
            "state": "VA",
            "postal_code": "201662612",
            "telephone_number": "703-542-7300",
            "fax_number": "703-754-1694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24565 DULLES LANDING DR",
            "address_2": "SUITE 190",
            "city": "DULLES",
            "state": "VA",
            "postal_code": "201662612",
            "telephone_number": "703-468-0188",
            "fax_number": "703-754-1694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TJB OF DULLES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-22",
        "last_updated": "2015-09-22",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "KERRI",
        "authorized_official_title_or_position": "REGIONAL DIRECTOR",
        "authorized_official_telephone_number": "540-494-8776"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "VA",
            "license": "0401007652",
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "VA",
            "license": "0401410720",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Loudoun Dental Associates & Smilez Pediatric Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dental Clinic/Center in Dulles, VA
• Providers in Dulles, VA by specialty
• Dental Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2015; 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.