NPIMap

Organization Active NPI

Kids & Family Dental, P.C.

  • General Practice Dentistry
  • Manassas, VA
National Provider Identifier
1689933582
Registry record updated May 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
0401413527 Issued in VA
Legal business name
KIDS & FAMILY DENTAL, P.C.
Practice address
9012 Mathis Ave
Manassas, VA 20110-5218
Phone
(571) 921-1111
NPI assigned
May 11, 2012
Last updated
May 11, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2012

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

Authorized official

Name
Jeremy Hodge, D.M.D.NPI 1194891242
Title
Owner
Phone
(571) 921-1111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 0401413527 VA Primary

Addresses

Primary practice location

9012 Mathis Ave
Manassas, VA 20110-5218

Mailing address

9012 Mathis Ave
Manassas, VA 20110-5218
Phone (571) 921-1111

National Provider Directory

National Provider Directory

Locations

9012 Mathis Ave
Manassas, VA 20110
Phone (571) 912-1111

Practitioners & affiliated clinicians

Practitioners 6

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": "1336694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336694400000",
    "number": "1689933582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9012 MATHIS AVE",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201105218",
            "telephone_number": "571-921-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9012 MATHIS AVE",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201105218",
            "telephone_number": "571-921-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS & FAMILY DENTAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-11",
        "last_updated": "2012-05-11",
        "status": "A",
        "authorized_official_last_name": "HODGE",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "571-921-1111",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401413527",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manassas, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 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.

Verify at the official NPI Registry.