Walter Emanuel Odisho, DDS

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

0401416043 Issued in VA

Practice address

3040 Williams Dr Ste 201
Fairfax, VA 22031

Phone

(571) 419-6897

NPI assigned

Jul 23, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Nana Dickson, DDS PC

  dba Allegra Dental Center

  • Dentist
  • Fairfax, VA
  • NPI 1437521598
  NPD (past)

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

{
    "created_epoch": "1437609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526515200000",
    "number": "1710362447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 N CALVERT ST APT 1502",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212022259",
            "telephone_number": "786-333-6862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3040 WILLIAMS DR STE 201",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "22031",
            "telephone_number": "571-419-6897"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "650 W Baltimore St Fl 4",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212011510",
            "country_code": "US",
            "telephone_number": "410-706-7101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ODISHO",
        "first_name": "WALTER",
        "middle_name": "EMANUEL",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-23",
        "last_updated": "2018-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "VA",
            "license": "0401416043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lynn Murphy Obrien, MD
• Occupational Health Centers of the Southwest P.a. (Concentra Medical Centers)
• Daniela Ochoa Paz, LMSW
• Camrey K Oczkowski, LGPC, ATR
• Mary Oddoux, MSW, LCSW
• Windi Carol Oehms
• Ofd PC (Oakton Family Dentistry)
• Mun Sik Oh
• Tae Ju Oh
• Taylor V. Oh, MS.D.

• Prosthodontics in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Prosthodontics in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2018; 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.