NPIMap

Organization Active NPI

Pediatric Dentistry of King George

  • Pediatric Dentistry
  • King George, VA
National Provider Identifier
1659724185
Registry record updated Jul 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
0401413260 Issued in VA
Legal business name
PEDIATRIC DENTISTRY OF KING GEORGE
Practice address
10246 Kings Hwy
King George, VA 22485-3429
Phone
(540) 625-2007
Fax
(540) 371-9539
NPI assigned
Jul 20, 2016
Last updated
Jul 20, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2016

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

Authorized official

Name
Dr. Justin Edwards, DMD
Title
Owner
Phone
(540) 625-2007

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 0401413260 VA Primary

Addresses

Primary practice location

10246 Kings Hwy
King George, VA 22485-3429

Mailing address

1300 Thornton St
Suite 101
Fredericksburg, VA 22401-4654
Phone (540) 371-3222

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1468972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468972800000",
    "number": "1659724185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 THORNTON ST",
            "address_2": "SUITE 101",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224014654",
            "telephone_number": "540-371-3222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10246 KINGS HWY",
            "city": "KING GEORGE",
            "state": "VA",
            "postal_code": "224853429",
            "telephone_number": "540-625-2007",
            "fax_number": "540-371-9539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTISTRY OF KING GEORGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-20",
        "last_updated": "2016-07-20",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "540-625-2007",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "VA",
            "license": "0401413260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in King George, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2016; 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.