Nickie Rose Bastani, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

2901020839 Issued in MI

Practice address

3700 Joseph Siewick Dr Ste 104
Fairfax, VA 22033-1737

Phone

(703) 620-9122

NPI assigned

Oct 30, 2012

Last updated

Jan 21, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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.

• Shohreh Sharif DDS PC

  • Pediatric Dentistry
  • Fairfax, VA
  • NPI 1215091541
  NPD (past)

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

{
    "created_epoch": "1351555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1801140892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1363 TATE MODERN LANE",
            "city": "GREAT FALLS",
            "state": "VA",
            "postal_code": "22066",
            "telephone_number": "571-426-8274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 JOSEPH SIEWICK DR STE 104",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220331737",
            "telephone_number": "703-620-9122"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1011 N University Ave",
            "address_purpose": "LOCATION",
            "city": "Ann Arbor",
            "state": "MI",
            "postal_code": "481091078",
            "country_code": "US",
            "telephone_number": "734-764-1522",
            "fax_number": "734-763-8100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BASTANI",
        "first_name": "NICKIE",
        "middle_name": "ROSE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-30",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901020839",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MI",
            "license": "2901020839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ankus Basnet
• Grace F Bass, OTR/L
• Paula Bass, PHD
• Catherine Clodagh Bassett
• Michael Karim Bassiri, DDS
• Megan Bastawrous, FNP-C
• Ingrid P Basurto
• Treona D Bateman, LCSW
• Mendsaikhan Baterdene, VA
• Brian Bateson, D.O.

• Pediatric Dentistry in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Pediatric Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2021; 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.