NPIMap

Organization Active NPI

Impact Dental Care Stafford PLLC

  • Dentist
  • Stafford, VA
National Provider Identifier
1720659535
Registry record updated Jul 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
IMPACT DENTAL CARE STAFFORD PLLC
Practice address
315 Garrisonville Rd Ste 105B
Stafford, VA 22554-1543
Phone
(540) 930-6500
NPI assigned
Jul 2, 2021
Last updated
Jul 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2021

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

Authorized official

Name
Palwinder KaurNPI 1477748887
Title
Manager
Phone
(703) 380-1246

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
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

315 Garrisonville Rd Ste 105B
Stafford, VA 22554-1543

Mailing address

13308 Regal Crest Dr
Clifton, VA 20124-0979

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1625184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625184000000",
    "number": "1720659535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13308 REGAL CREST DR",
            "city": "CLIFTON",
            "state": "VA",
            "postal_code": "201240979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 GARRISONVILLE RD STE 105B",
            "city": "STAFFORD",
            "state": "VA",
            "postal_code": "225541543",
            "telephone_number": "540-930-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT DENTAL CARE STAFFORD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-02",
        "last_updated": "2021-07-02",
        "certification_date": "2021-07-02",
        "status": "A",
        "authorized_official_last_name": "KAUR",
        "authorized_official_first_name": "PALWINDER",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "703-380-1246"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "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 Jul 2, 2021; 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.