Alexandria Old Town Dental PLLC

Primary specialty

DentistTaxonomy code 122300000X

License

0401004117 Issued in VA

Legal business name

ALEXANDRIA OLD TOWN DENTAL PLLC

Practice address

1421 Prince St Ste 140
Alexandria, VA 22314-2771

Phone

(703) 549-1331

Fax

(703) 549-0480

NPI assigned

Jan 31, 2018

Last updated

Sep 8, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Eddie Seymour Longman, DDSNPI 1902978828

Title

Dentist/Owner

Phone

(703) 549-1331

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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.

• Eddie S Longman, D.D.S.

  • General Practice Dentistry
  • Alexandria, VA
  • NPI 1902978828
  NPD Authorized official
• Wanda M Goldhush, D.D.S.

  • General Practice Dentistry
  • Alexandria, VA
  • NPI 1831261767
  NPD
• Denis A Peper, D.D.S.

  • General Practice Dentistry
  • Alexandria, VA
  • NPI 1568593028
  NPD
• Anh-Minh Phan, D.D.S.

  • Prosthodontics
  • Alexandria, VA
  • NPI 1033281803
  NPD

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

{
    "created_epoch": "1517356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599523200000",
    "number": "1518465939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1421 PRINCE ST STE 140",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223142771",
            "telephone_number": "703-549-1331",
            "fax_number": "703-549-0480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421 PRINCE ST STE 140",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223142771",
            "telephone_number": "703-549-1331",
            "fax_number": "703-549-0480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALEXANDRIA OLD TOWN DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-31",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-08",
        "status": "A",
        "authorized_official_last_name": "LONGMAN",
        "authorized_official_first_name": "EDDIE",
        "authorized_official_middle_name": "SEYMOUR",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "703-549-1331",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401004117",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GENERAL DENTIST",
            "identifier": "541192045",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexandria Med Clinic
• Alexandria Medical Center, Inc (Alexandria Medical Center)
• Alexandria Mental Health
• Alexandria Midwife
• Alexandria Neighborhood Health Services, Inc. (ANHSI-King Street Dental)
• Alexandria Operator LLC (Alexandria Rehabilitation and Healthcare Center)
• Alexandria Ophthalmic Associates, P.C.
• Alexandria Optimum Health LLC (Optimum Health LLC)
• Alexandria Optometry, PLLC (My Eye Dr)
• Alexandria Oral Surgery, PLLC

• Dentist in Alexandria, VA
• Providers in Alexandria, VA by specialty
• Dentist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2020; 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.