NPIMap

Organization Active NPI

Bradley D Wiltbank DMD PC

  • General Practice Dentistry
  • MC Lean, VA
National Provider Identifier
1528468402
Registry record updated Sep 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
BRADLEY D WILTBANK DMD PC
Doing business as
Dolley Madison Dentistry
Practice address
1313 Dolley Madison Blvd Ste 209
MC Lean, VA 22101-3926
Phone
(703) 356-7890
NPI assigned
Aug 28, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2014

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

Authorized official

Name
Brad D Wiltbank, DMD
Title
Owner
Phone
(703) 356-7890

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary
Customized Equipment (DME) 332BC3200X

Addresses

Primary practice location

1313 Dolley Madison Blvd Ste 209
MC Lean, VA 22101-3926

Mailing address

1313 Dolley Madison Blvd Ste 209
MC Lean, VA 22101-3926

Other names 1

  • Dolley Madison Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

1313 Dolley Madison Blvd
Ste 209
McLean, VA 22101
Phone (703) 356-7890

Practitioners & affiliated clinicians

Practitioners 4

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": "1409184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410134400000",
    "number": "1528468402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1313 DOLLEY MADISON BLVD STE 209",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221013926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1313 DOLLEY MADISON BLVD STE 209",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221013926",
            "telephone_number": "703-356-7890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRADLEY D WILTBANK DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-28",
        "last_updated": "2014-09-08",
        "status": "A",
        "authorized_official_last_name": "WILTBANK",
        "authorized_official_first_name": "BRAD",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-356-7890",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dolley Madison Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in MC Lean, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2014; 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.