NPIMap

Organization Active NPI

Pediatric and Adolescent Dentistry PC

  • Pediatric Dentistry
  • Alexandria, VA
National Provider Identifier
1558639906
Registry record updated Dec 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
0401008254 Issued in VA
Legal business name
PEDIATRIC AND ADOLESCENT DENTISTRY PC
Practice address
4605D Pinecrest Office Park Dr
Alexandria, VA 22312-1442
Phone
(703) 352-4121
NPI assigned
Dec 13, 2011
Last updated
Dec 13, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2011

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

Authorized official

Name
Dr. Faranak Ghalehbaghi, DDSNPI 1821308115
Title
Pediatric Dentist
Phone
(703) 352-4121

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 0401008254 VA Primary

Addresses

Primary practice location

4605D Pinecrest Office Park Dr
Alexandria, VA 22312-1442

Mailing address

4605D Pinecrest Office Park Dr
Alexandria, VA 22312-1442
Phone (703) 352-4121

Other identifiers 2

IdentifierTypeStateIssuer
1548359649MedicaidVA
1821308115MedicaidVA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1323734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323734400000",
    "number": "1558639906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4605D PINECREST OFFICE PARK DR",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223121442",
            "telephone_number": "703-352-4121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4605D PINECREST OFFICE PARK DR",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223121442",
            "telephone_number": "703-352-4121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC AND ADOLESCENT DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-13",
        "last_updated": "2011-12-13",
        "status": "A",
        "authorized_official_last_name": "GHALEHBAGHI",
        "authorized_official_first_name": "FARANAK",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "703-352-4121",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "VA",
            "license": "0401008254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1548359649",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821308115",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexandria, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2011; 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.