Pure Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PURE DENTAL LLC

Practice address

11864 Sunrise Valley Dr Ste 100
Reston, VA 20191-3311

Phone

(571) 236-6699

NPI assigned

Oct 13, 2023

Organization subpart

No

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

Authorized official

Name

Jae-Woo Jung, DDSNPI 1871089987

Title

Owner Doctor

Phone

(571) 236-6699

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• Jae-Woo Jung, DDS

  • General Practice Dentistry
  • Reston, VA
  • NPI 1871089987
  NPD Authorized official

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

{
    "created_epoch": "1697155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697155200000",
    "number": "1487436556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4631 HUMMINGBIRD LN",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220333745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11864 SUNRISE VALLEY DR STE 100",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201913311",
            "telephone_number": "571-236-6699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-13",
        "last_updated": "2023-10-13",
        "certification_date": "2023-10-13",
        "status": "A",
        "authorized_official_last_name": "JUNG",
        "authorized_official_first_name": "JAE-WOO",
        "authorized_official_title_or_position": "OWNER DOCTOR",
        "authorized_official_telephone_number": "571-236-6699",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Reston, VA
• Providers in Reston, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2023; 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.