Philip Joseph Pandolfi, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

0401007043 Issued in VA

Practice address

300 Central Ave
Fort Gregg Adams, VA 23801-1526

Phone

(804) 734-5454

NPI assigned

Dec 19, 2006

Last updated

Jul 10, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jun 1, 2017 through Jun 1, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Blue Ridge Oral Surgery, Inc.

  dba Blue Ridge Oral & Maxillofacial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Fishersville, VA
  • NPI 1710013446
  NPD (past)
• Gos Chesapeake PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Chesapeake, VA
  • NPI 1093663411
  NPD (past)
• Scott R Goodove DDS PLC

  dba Goodove Oral Surgery & Dental Implants

  • Oral and Maxillofacial Surgery (Dentist)
  • Virginia Beach, VA
  • NPI 1043498231
  NPD (past)

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1790848711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 CENTRAL AVE",
            "city": "FORT GREGG ADAMS",
            "state": "VA",
            "postal_code": "238011526",
            "telephone_number": "804-734-5454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 CENTRAL AVE",
            "city": "FORT GREGG ADAMS",
            "state": "VA",
            "postal_code": "238011526",
            "telephone_number": "804-734-5454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANDOLFI",
        "first_name": "PHILIP",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-19",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "VA",
            "license": "0401007043",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "139547",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dean Miller, MD
• Jared Mitchell
• Youngki Noh, DDS
• Kayla Ours, PA-C
• Taneshia Page
• Marichu M Parham
• Paul J Park, DMD
• Julia Patsell, FNP
• Robyn Marie Reale, PA-C
• Robert Scott Ruehrwein, DDS

• Oral and Maxillofacial Surgery (Dentist) in Fort Gregg Adams, VA
• Providers in Fort Gregg Adams, VA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.