GD VA South Riding PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

GD VA SOUTH RIDING PLLC

Doing business as

South Riding Smiles

Practice address

25055 Riding PLZ Ste 250
South Riding, VA 20152-5921

Phone

(703) 327-7705

NPI assigned

Mar 17, 2023

Organization subpart

No

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

Authorized official

Name

Chad Hendricks

Title

Credentialing

Phone

(612) 859-0444

Specialties & licenses 1

Addresses

Other names 1

• South Riding Smiles Doing business as

Locations

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

{
    "created_epoch": "1679011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679011200000",
    "number": "1730881590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25055 RIDING PLZ STE 250",
            "city": "SOUTH RIDING",
            "state": "VA",
            "postal_code": "201525921",
            "telephone_number": "703-327-7705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25055 RIDING PLZ STE 250",
            "city": "SOUTH RIDING",
            "state": "VA",
            "postal_code": "201525921",
            "telephone_number": "703-327-7705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GD VA SOUTH RIDING PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-17",
        "last_updated": "2023-03-17",
        "certification_date": "2023-03-17",
        "status": "A",
        "authorized_official_last_name": "HENDRICKS",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "612-859-0444"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Riding Smiles",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in South Riding, VA
• Providers in South Riding, 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 Mar 17, 2023; 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.