Peter M Tan Jr., DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

4367 Issued in WV

Practice address

2480 Llewellyn Ave
Fort George G Meade, MD 20755-7081

Phone

(301) 677-8956

NPI assigned

Aug 3, 2015

Sex

Male

Sole proprietor

Yes

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

Enrolled in MD

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 and National Provider Directory roles.

• Northern Virginia Oral and Facial Surgery, LLC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Alexandria, VA
  • NPI 1003701277

  Single Specialty

  NPD (past)
• Northern Virginia Oral and Facial Surgery, LLC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Ashburn, VA
  • NPI 1013718071

  Single Specialty

  NPD (past)
• Northern Virginia Oral and Facial Surgery, LLC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Warrenton, VA
  • NPI 1407657455

  Single Specialty

  NPD (past)
• Northern Virginia Oral and Facial Surgery, LLC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Falls Church, VA
  • NPI 1780485730

  Single Specialty

  NPD (past)
• Northern Virginia Oral and Facial Surgery, LLC

  • Oral and Maxillofacial Surgery Clinic/Center
  • Fairfax, VA
  • NPI 1831526995
  NPD (past)
• Northern Virginia Oral and Facial Surgery, LLC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Gainesville, VA
  • NPI 1831990886

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1438560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655078400000",
    "number": "1932585916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1553 HUGO CIR",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209065918",
            "telephone_number": "301-639-2536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2480 LLEWELLYN AVE",
            "city": "FORT GEORGE G MEADE",
            "state": "MD",
            "postal_code": "207557081",
            "telephone_number": "301-677-8956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "PETER",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-08-03",
        "last_updated": "2022-06-13",
        "certification_date": "2022-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MD",
            "license": "15999",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WV",
            "license": "4367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Kiel Sracic, M.D.
• Lindsay Allen Stuhlmacher, RN
• Meghan Swafford, PA
• Gloria June Sweeney
• Andrew Tallman, PA-C
• Saadia T Taylor
• Virginia Taylor
• Sallie E Teal, LPN
• Richard K. Temofeew, MD
• Natacha Thomas

• Oral and Maxillofacial Surgery (Dentist) in Fort George G Meade, MD
• Providers in Fort George G Meade, MD by specialty
• Oral and Maxillofacial Surgery (Dentist) in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2022; 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.