DRS. Soderquist & Weis, P. C.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

S4157/ W8596 Issued in VA

Legal business name

DRS. SODERQUIST & WEIS, P. C.

Practice address

1101 E Jefferson St
Charlottesville, VA 22902-5353

Phone

(434) 971-9601

Fax

(434) 971-9646

NPI assigned

Jul 29, 2006

Organization subpart

No

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

Authorized official

Name

Miss Judy H Burruss

Title

Office Manager

Phone

(434) 971-9601

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1720093693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 E JEFFERSON ST",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229025353",
            "telephone_number": "434-971-9601",
            "fax_number": "434-971-9646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 E JEFFERSON ST",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229025353",
            "telephone_number": "434-971-9601",
            "fax_number": "434-971-9646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRS. SODERQUIST & WEIS, P. C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-29",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BURRUSS",
        "authorized_official_first_name": "JUDY",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "434-971-9601",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "VA",
            "license": "S4157/  W8596",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9178262",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9178339",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• 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.