NPIMap

Organization Active NPI

Ashburn Divine Dental

  • Dentist
  • Ashburn, VA
National Provider Identifier
1750633301
Registry record updated Oct 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0401413081 Issued in VA
Legal business name
ASHBURN DIVINE DENTAL
Practice address
20915 Ashburn Rd Ste 205
Ashburn, VA 20147-5679
Phone
(626) 377-0550
NPI assigned
Oct 5, 2012
Last updated
Oct 5, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2012

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

Authorized official

Name
Lulu LinNPI 1962738252
Title
President
Phone
(626) 377-0550

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 0401413081 VA Primary

Addresses

Primary practice location

20915 Ashburn Rd Ste 205
Ashburn, VA 20147-5679

Mailing address

20915 Ashburn Rd Ste 205
Ashburn, VA 20147-5679

National Provider Directory

National Provider Directory

Locations

20915 Ashburn Rd
Ste 205
Ashburn, VA 20147
Phone (626) 377-0550

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": "1349395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349395200000",
    "number": "1750633301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20915 ASHBURN RD STE 205",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201475679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20915 ASHBURN RD STE 205",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201475679",
            "telephone_number": "626-377-0550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASHBURN DIVINE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-05",
        "last_updated": "2012-10-05",
        "status": "A",
        "authorized_official_last_name": "LIN",
        "authorized_official_first_name": "LULU",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "626-377-0550"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401413081",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ashburn, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2012; 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.