Active NPI
Jim Misto, DDS
- Dentist
- Stafford, VA
National Provider Identifier
1710035233
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 0401411764
- Practice address
- 481 Garrisonville Rd Ste 105
Stafford, VA 22554-1601 - Phone
- (540) 659-4900
- Fax
- (540) 659-4935
- NPI assigned
- Jan 8, 2007
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 0401411764 | VA | Primary |
Addresses
Primary practice location
481 Garrisonville Rd Ste 105
Stafford, VA 22554-1601
Mailing address
481 Garrisonville Rd Ste 105
Stafford, VA 22554-1601
Phone (540) 659-4900
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 |
|---|---|---|---|
| 0401411764 | VA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Garrisonville Dental LLC | 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.
-
- Dental Clinic/Center
- Stafford, VA
- NPI 1811183734
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328486400000",
"number": "1710035233",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "481 GARRISONVILLE RD STE 105",
"city": "STAFFORD",
"state": "VA",
"postal_code": "225541601",
"telephone_number": "540-659-4900",
"fax_number": "540-659-4935"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "481 GARRISONVILLE RD STE 105",
"city": "STAFFORD",
"state": "VA",
"postal_code": "225541601",
"telephone_number": "540-659-4900",
"fax_number": "540-659-4935"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MISTO",
"first_name": "JIM",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-08",
"last_updated": "2012-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": "0401411764",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Feb 6, 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.