Stafford Prosthodontics PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

STAFFORD PROSTHODONTICS PLLC

Doing business as

Innova Prosthodontics & Dental Implant Center

Practice address

5252 Dawes Ave
Alexandria, VA 22311-1404

Phone

(703) 933-8500

Fax

(703) 933-8506

NPI assigned

Jan 8, 2024

Last updated

Jan 8, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Elias Reategui

Title

Office Manager

Phone

(703) 933-8500

Specialties & licenses 1

Addresses

Other names 1

• Innova Prosthodontics & Dental Implant Center Doing business as

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

{
    "created_epoch": "1704672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704672000000",
    "number": "1720858061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5252 DAWES AVE",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223111404",
            "telephone_number": "703-933-8500",
            "fax_number": "703-933-8506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5252 DAWES AVE",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223111404",
            "telephone_number": "703-933-8500",
            "fax_number": "703-933-8506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAFFORD PROSTHODONTICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-08",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A",
        "authorized_official_last_name": "REATEGUI",
        "authorized_official_first_name": "ELIAS",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "703-933-8500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Innova Prosthodontics & Dental Implant Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ekta Srikumar, M.D.
• Abhijit Srungavarapu, MD
• St Angele Healthcare Services Inc
• Mikal Ja'Quinn St Mark, RN
• Laura St. Bernard
• William Syms Stage, M.D.
• Stephanie Stahr, DPT
• Zanathia Stalling
• Matthew Lawrence Stampe, LAC
• Erin Stanclift

• General Practice Dentistry in Alexandria, VA
• Providers in Alexandria, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2024; 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.