Active NPI
Jason Dennis Brandt, D.D.S.
- Dentist
- Woodbridge, VA
National Provider Identifier
1942204813
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 0401008838
- Practice address
- 13663 Office PL
Ste 103
Woodbridge, VA 22192-4216 - Phone
- (703) 878-2100
- Fax
- (703) 878-2422
- NPI assigned
- Jun 9, 2005
- Last updated
- Apr 26, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0401008838 | VA | Primary |
Addresses
Primary practice location
13663 Office PL
Ste 103
Woodbridge, VA 22192-4216
Mailing address
13663 Office PL
Ste 103
Woodbridge, VA 22192-4216
Phone (703) 878-2100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Mar 29, 2016 through Mar 29, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401008838 | VA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1303776000000",
"number": "1942204813",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13663 OFFICE PL",
"address_2": "STE 103",
"city": "WOODBRIDGE",
"state": "VA",
"postal_code": "221924216",
"telephone_number": "703-878-2100",
"fax_number": "703-878-2422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13663 OFFICE PL",
"address_2": "STE 103",
"city": "WOODBRIDGE",
"state": "VA",
"postal_code": "221924216",
"telephone_number": "703-878-2100",
"fax_number": "703-878-2422"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRANDT",
"first_name": "JASON",
"middle_name": "DENNIS",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-09",
"last_updated": "2011-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": "0401008838",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodbridge, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2011; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.