NPIMap

Organization Active NPI

Commonwealth of Virginia State Board of Health

Doing business as Stafford Dental

  • Public Health Dentistry
  • Stafford, VA
National Provider Identifier
1629089750
Registry record updated Aug 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health DentistryTaxonomy code 1223D0001X
Legal business name
COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Doing business as
Stafford Dental
Practice address
1739 Jefferson Davis Hwy
Stafford, VA 22554-7213
Phone
(540) 288-2579
Fax
(540) 288-3796
NPI assigned
Aug 11, 2006
Last updated
Aug 25, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2008

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

Authorized official

Name
Jane Krakowsky
Title
Business Manager
Phone
(540) 899-4797

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health Dentistry 1223D0001X NU Primary

Addresses

Primary practice location

1739 Jefferson Davis Hwy
Stafford, VA 22554-7213

Mailing address

608 Jackson St
Fredericksburg, VA 22401-5719
Phone (540) 899-4797

Other identifiers 2

IdentifierTypeStateIssuer
104852OtherVADORAL
144853OtherVAANTHEM-MILLER

Other names 1

  • Stafford Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dickenson Co Health Dep163 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219622400000",
    "number": "1629089750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "608 JACKSON ST",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224015719",
            "telephone_number": "540-899-4797",
            "fax_number": "540-899-4599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1739 JEFFERSON DAVIS HWY",
            "city": "STAFFORD",
            "state": "VA",
            "postal_code": "225547213",
            "telephone_number": "540-288-2579",
            "fax_number": "540-288-3796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-11",
        "last_updated": "2008-08-25",
        "status": "A",
        "authorized_official_last_name": "KRAKOWSKY",
        "authorized_official_first_name": "JANE",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "540-899-4797"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DORAL",
            "identifier": "104852",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM-MILLER",
            "identifier": "144853",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stafford Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Aug 25, 2008; 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.