Active NPI
Osama Shoueb Modjadidi, D.M.D.
- General Practice Dentistry
- Chesapeake, VA
National Provider Identifier
1679739312
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 10783
- Practice address
- 113 Gainsborough SQ
Suite 101
Chesapeake, VA 23320-1713 - Phone
- (757) 548-5619
- Fax
- (757) 548-6930
- NPI assigned
- Aug 1, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 10783 | VA | Primary |
Addresses
Primary practice location
113 Gainsborough SQ
Suite 101
Chesapeake, VA 23320-1713
Mailing address
113 Gainsborough SQ
Suite 101
Chesapeake, VA 23320-1713
Phone (757) 548-5619
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10783 | VA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Harmony Dental Group | General Practice | 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.
-
- General Practice Dentistry
- Virginia Beach, VA
- NPI 1891119277
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1217548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1349827200000",
"number": "1679739312",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "113 GAINSBOROUGH SQ",
"address_2": "SUITE 101",
"city": "CHESAPEAKE",
"state": "VA",
"postal_code": "233201713",
"telephone_number": "757-548-5619",
"fax_number": "757-548-6930"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "113 GAINSBOROUGH SQ",
"address_2": "SUITE 101",
"city": "CHESAPEAKE",
"state": "VA",
"postal_code": "233201713",
"telephone_number": "757-548-5619",
"fax_number": "757-548-6930"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MODJADIDI",
"first_name": "OSAMA",
"middle_name": "SHOUEB",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-08-01",
"last_updated": "2012-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "VA",
"license": "10783",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chesapeake, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.