Active NPI
Avi Benjamin Gibberman, D.D.S.
- Dentist
- Alexandria, VA
National Provider Identifier
1609069988
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- Practice address
- 4613 Duke St
Alexandria, VA 22304-2594 - Phone
- (703) 823-6616
- Fax
- (703) 823-2141
- NPI assigned
- Aug 21, 2007
- Sex
- Male
- 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 | VA | Primary |
Addresses
Primary practice location
4613 Duke St
Alexandria, VA 22304-2594
Mailing address
4616 Duke Street
Alexandria, VA 22304
Phone (703) 823-6616
Other names 1
- Dr. Avi Benjamin Gibberman
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160328000002 | VA | Order and Referring Only - Dentist | 6406153006 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 040141023 | VA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lauren Gibberman DDS PLLC | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187654400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187654400000",
"number": "1609069988",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4616 DUKE STREET",
"city": "ALEXANDRIA",
"state": "VA",
"postal_code": "22304",
"telephone_number": "703-823-6616",
"fax_number": "703-823-2141"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4613 DUKE ST",
"city": "ALEXANDRIA",
"state": "VA",
"postal_code": "223042594",
"telephone_number": "703-823-6616",
"fax_number": "703-823-2141"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBBERMAN",
"first_name": "AVI",
"middle_name": "BENJAMIN",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-08-21",
"last_updated": "2007-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "AVI",
"last_name": "GIBBERMAN",
"middle_name": "BENJAMIN",
"prefix": "DR.",
"credential": "D.D.S.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Alexandria, VA
- Giant of Maryland LLC (Giant Pharmacy 242)
- Giant of Maryland LLC (Giant Pharmacy 232)
- Giant of Maryland LLC (Giant Pharmacy #2742)
- Giant of Maryland LLC (Giant Pharmacy 777)
- Giant of Maryland LLC (Giant Pharmacy 760)
- Lauren Beth Gibberman, D.D.S.
- Paul Gibberman, D.D.S.
- Layna Myleen Gibbs
- Madelyn Giblin, MSW
- Briana Lin Gibson
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.