Boulevard Dental Clinic

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

0401008771 Issued in VA

Legal business name

BOULEVARD DENTAL CLINIC

Practice address

8301 Arlington Blvd
Suite #403
Fairfax, VA 22031-2902

Phone

(703) 206-0466

Fax

(703) 206-0479

NPI assigned

May 14, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Ricardo Moises Gaitan, DDS/PC

Title

General Dentist

Phone

(703) 206-0466

Specialties & licenses 1

Addresses

Other names 1

• Dr Ricardo M Gaitan DDS/PC Other name

Locations

Practitioners 1

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

• Ricardo Sixto Gaitan, DDS

  • General Practice Dentistry
  • Fairfax, VA
  • NPI 1053039248
  NPD (past)

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

{
    "created_epoch": "1210723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210723200000",
    "number": "1639346182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8301 ARLINGTON BLVD",
            "address_2": "SUITE #403",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220312902",
            "telephone_number": "703-206-0466",
            "fax_number": "703-206-0479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8301 ARLINGTON BLVD",
            "address_2": "SUITE #403",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220312902",
            "telephone_number": "703-206-0466",
            "fax_number": "703-206-0479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULEVARD DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-14",
        "last_updated": "2008-05-14",
        "status": "A",
        "authorized_official_last_name": "GAITAN",
        "authorized_official_first_name": "RICARDO",
        "authorized_official_middle_name": "MOISES",
        "authorized_official_title_or_position": "GENERAL DENTIST",
        "authorized_official_telephone_number": "703-206-0466",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS/PC"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "VA",
            "license": "0401008771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr Ricardo M Gaitan DDS/PC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Anna Michele Bosworth, OTD, OTR/L
• Lorena Botero Calderon, M.D.
• Kaitlyn Botz
• Michelle Bouboulis, OTR/L
• Anna Bougie, RDN
• Boulevard Operator LLC
• Boundless Nutrition LLC
• Mary Ann Bourgeois
• Kailey E Bousquet
• Martha Jean Bouveron

• Dental Clinic/Center in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Dental Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 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.