Prince William Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PRINCE WILLIAM DENTAL LLC

Practice address

7051 Heathcote Village Way Ste 100
Gainesville, VA 20155-3197

Phone

(848) 667-0516

NPI assigned

May 19, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Madhusudhan Reddy Kasipathy, DDSNPI 1316100639

Title

Dentist/ Owner

Phone

(848) 667-0516

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Madhusudhan Reddy Kasipathy, DDS

  • Dentist
  • MC Lean, VA
  • NPI 1316100639
  NPD Authorized official

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

{
    "created_epoch": "1589846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589846400000",
    "number": "1609499151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43313 BARNSTEAD DR",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201486890",
            "telephone_number": "848-667-0516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7051 HEATHCOTE VILLAGE WAY STE 100",
            "city": "GAINESVILLE",
            "state": "VA",
            "postal_code": "201553197",
            "telephone_number": "848-667-0516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRINCE WILLIAM DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-19",
        "last_updated": "2020-05-19",
        "certification_date": "2020-05-19",
        "status": "A",
        "authorized_official_last_name": "KASIPATHY",
        "authorized_official_first_name": "MADHUSUDHAN",
        "authorized_official_middle_name": "REDDY",
        "authorized_official_title_or_position": "DENTIST/ OWNER",
        "authorized_official_telephone_number": "848-667-0516",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MADHUSUDHAN KASIPATHY",
            "identifier": "1316100639",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KOWSHIK VADDI",
            "identifier": "1750583738",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Potomac Behavioral Health LLC
• Anne Powell, FNP
• Powerback Rehabilitation LLC
• Premier Medical Transport LLC
• Prime Physical Therapy LLC
• Prince William Dermatology, P.C.
• Prince William H&R Ops Limited Partnership
• Prince William OBGYN Associates, LTD
• Pristine Healthcare Services, LLC
• Stephane Provencher, D.C.

• General Practice Dentistry in Gainesville, VA
• Providers in Gainesville, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 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.