Lakeridge Dental Associates

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

0401008767 Issued in VA

Legal business name

LAKERIDGE DENTAL ASSOCIATES

Practice address

12506 Lake Ridge Dr
Woodbridge, VA 22192-2397

Phone

(571) 408-4459

NPI assigned

Jun 19, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Sasan Ahmadiyar, DDS

Title

Dentist/Owner

Phone

(540) 710-6000

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1403136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403136000000",
    "number": "1902210776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12506 LAKE RIDGE DR",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221922397",
            "telephone_number": "571-408-4459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12506 LAKE RIDGE DR",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221922397",
            "telephone_number": "571-408-4459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKERIDGE DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-19",
        "last_updated": "2014-06-19",
        "status": "A",
        "authorized_official_last_name": "AHMADIYAR",
        "authorized_official_first_name": "SASAN",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "540-710-6000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "VA",
            "license": "0401008767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake Ridge Orthodontics PC
• Lake Ridge Pediatric Dentistry PLLC (Lake Ridge Pediatric Dentistry)
• Lake Ridge Physical Therapy, LLC
• Lake Ridge Vision Center PLLC
• Lake Ridge Vision Center, Inc
• Lakeridgesmiles
• Rebecca 'Becca' A Lakin, M.ED.
• Elizabeth Lambiotte, SLP
• Madhab Lamichhane, M.D.
• Sean Matthew Lamphier, FNP-C

• Preferred Provider Organization in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Preferred Provider Organization in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2014; 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.