Individual provider Active NPI

Mary-Stuart Gallian, D.M.D

  • General Practice Dentistry
  • Fairfax, VA
National Provider Identifier
1891992707
Registry record updated Jun 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
0401412122 Issued in VA
Practice address
10090 Main St Ste 201
Fairfax, VA 22031-3412
Phone
(703) 273-4500
Fax
(703) 273-9067
NPI assigned
Jul 3, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 5556 AL
General Practice Dentistry 1223G0001X 0401412122 VA Primary

Addresses

Primary practice location

10090 Main St Ste 201
Fairfax, VA 22031-3412

Mailing address

10090 Main St Ste 201
Fairfax, VA 22031-3412
Phone (703) 273-4500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
5556ALMDGeneral Practice Dentistry
0401412122VAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1183420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213660800000",
    "number": "1891992707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10090 MAIN ST STE 201",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220313412",
            "telephone_number": "703-273-4500",
            "fax_number": "703-273-9067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10090 MAIN ST STE 201",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220313412",
            "telephone_number": "703-273-4500",
            "fax_number": "703-273-9067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLIAN",
        "first_name": "MARY-STUART",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-03",
        "last_updated": "2008-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "5556",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401412122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; 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.