Justin DO

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401416976 Issued in VA

Practice address

14007 Minnieville Rd
Woodbridge, VA 22193-2310

Phone

(703) 670-5414

NPI assigned

Apr 29, 2019

Last updated

Oct 19, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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.

Enrollment records 1

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.

• DO Tan Partners

  • General Practice Dentistry
  • Silver Spring, MD
  • NPI 1750257523
  NPD Authorized official
• Anderson Dental Associates II PLLC

  dba RenovaSmiles Woodbridge

  • General Practice Dentistry
  • Woodbridge, VA
  • NPI 1013368398
  NPD (past)

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

{
    "created_epoch": "1556496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634601600000",
    "number": "1881258408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12809 PILOTS LANDING WAY APT SUITE",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208786118",
            "telephone_number": "240-644-5394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14007 MINNIEVILLE RD",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221932310",
            "telephone_number": "703-670-5414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DO",
        "first_name": "JUSTIN",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-29",
        "last_updated": "2021-10-19",
        "certification_date": "2021-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401416976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Divine Senior Home Care LLC
• Annalisa Divito
• Hengameh Djalal
• DMV Sports Medicine Institute
• Cuong Hoang DO, MD
• Thao Phuong Doan, D.D.S.
• Yolunda G Dockett, OTD, OTR/L
• Lovelace Doffour
• Andranita Dogan, MS, LPC, NCC, CCMHC
• Samuel Dogbey, PA

• General Practice Dentistry in Woodbridge, VA
• Providers in Woodbridge, 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 Oct 19, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.