Active NPI
Jessica Paola Sugajara Mitsuzuka, D.D.S.
- Dentist
- Stafford, VA
National Provider Identifier
1538392162
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 0401413419
- Practice address
- 385 Garrisonville Rd Suite 108
Stafford, VA 22554 - Phone
- (540) 657-7645
- Fax
- (540) 657-1009
- NPI assigned
- Aug 31, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0401413419 | VA | Primary |
Addresses
Primary practice location
385 Garrisonville Rd Suite 108
Stafford, VA 22554
Mailing address
385 Garrisonville Rd Siute 108
Stafford, VA 22554
Phone (540) 657-7645
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538392162 | Medicaid | VA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401413419 | VA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| VA Smiles Dental Center PLLC | Dentist | Past | Accepting new patients |
| Sasan Ahmadiyar DDS & Associates | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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- Dentist
- Fredericksburg, VA
- NPI 1245945989
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251676800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1481241600000",
"number": "1538392162",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "385 GARRISONVILLE RD SIUTE 108",
"city": "STAFFORD",
"state": "VA",
"postal_code": "22554",
"telephone_number": "540-657-7645",
"fax_number": "540-657-1009"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "385 GARRISONVILLE RD SUITE 108",
"city": "STAFFORD",
"state": "VA",
"postal_code": "22554",
"telephone_number": "540-657-7645",
"fax_number": "540-657-1009"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUGAJARA MITSUZUKA",
"first_name": "JESSICA",
"middle_name": "PAOLA",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-08-31",
"last_updated": "2016-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": "0401413419",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1538392162",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stafford, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.