Promenade Complete Dental Center

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

PROMENADE COMPLETE DENTAL CENTER

Practice address

19340 Promenade Drive
Leesburg, VA 20176

Phone

(571) 333-8558

NPI assigned

Sep 1, 2016

Last updated

Sep 1, 2016By 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

Lisa Champney

Title

Office Manager

Phone

(571) 333-8558

Specialties & licenses 1

Addresses

Practitioners 2

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.

• Geovanny Balderas, DMD

  • General Practice Dentistry
  • Bridgewater, VA
  • NPI 1215585302
  NPD (past)
• Sabrina Lucia Hernandez Barazarte

  • Dentist
  • Ashburn, VA
  • NPI 1730873878
  NPD (past)

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

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472688000000",
    "number": "1750838363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19340 PROMENADE DRIVE",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "20176",
            "telephone_number": "571-333-8558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19340 PROMENADE DRIVE",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "20176",
            "telephone_number": "571-333-8558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMENADE COMPLETE DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-01",
        "last_updated": "2016-09-01",
        "status": "A",
        "authorized_official_last_name": "CHAMPNEY",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "571-333-8558"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Privia Medical Group, LLC (Catoctin Foot and Ankle Center LLC)
• Privia Medical Group, LLC
• Privia Medical Group, LLC (Catoctin Foot and Ankle Center)
• Pro Networks Inc. Dba Care Pro
• Progress Rehabilitation Network, LLC (Integrated Sports Medicine & Physical Therapy of Loudoun)
• Shabnam Prophet, PA-C
• Chuck G Pruna, D.O.
• Edward Vincent Puccio, MD
• Melissa Pujol, MSW
• Michael Jeffrey Pulizzi, MD

• Dental Clinic/Center in Leesburg, VA
• Providers in Leesburg, VA by specialty
• Dental Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; 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.