NPIMap

Organization Active NPI

Fairfax Dentistry, PLLC

  • General Practice Dentistry
  • Fairfax, VA
National Provider Identifier
1710496294
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
FAIRFAX DENTISTRY, PLLC
Practice address
11351 Random Hills Rd Ste 102
Fairfax, VA 22030-6081
Phone
(703) 691-2221
Fax
(703) 691-3215
NPI assigned
Sep 27, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Samuel Saeho Ham, DDSNPI 1568541753
Title
Owner/Dentist
Phone
(703) 691-2221

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 DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X VA Primary

Addresses

Primary practice location

11351 Random Hills Rd Ste 102
Fairfax, VA 22030-6081

Mailing address

11351 Random Hills Rd Ste 102
Fairfax, VA 22030-6081
Phone (703) 691-2221

Other names 1

  • Samuel S. Ham, DDS, PC Former legal business name

National Provider Directory

National Provider Directory

Locations

11351 Random Hills Rd
Ste 102
Fairfax, VA 22030
Phone (703) 691-2221

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1506470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1710496294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11351 RANDOM HILLS RD STE 102",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220306081",
            "telephone_number": "703-691-2221",
            "fax_number": "703-691-3215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11351 RANDOM HILLS RD STE 102",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220306081",
            "telephone_number": "703-691-2221",
            "fax_number": "703-691-3215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRFAX DENTISTRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-27",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "HAM",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "SAEHO",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "703-691-2221",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Samuel S. Ham, DDS, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Fairfax, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.