Active NPI
Carla Stephan
- Pediatric Dentistry
- MC Lean, VA
National Provider Identifier
1982138376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 4804
- Practice address
- 1625 International Dr Unit 120
MC Lean, VA 22102-4813 - Phone
- (202) 290-0356
- NPI assigned
- Apr 12, 2017
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 4804 | ZZ | Primary |
Addresses
Primary practice location
1625 International Dr Unit 120
MC Lean, VA 22102-4813
Mailing address
1625 International Dr Unit 120
MC Lean, VA 22102-4813
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
| License | State | Type | Specialty |
|---|---|---|---|
| 4804 | ZZ | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1491955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491955200000",
"number": "1982138376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1625 INTERNATIONAL DR UNIT 120",
"city": "MC LEAN",
"state": "VA",
"postal_code": "221024813"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1625 INTERNATIONAL DR UNIT 120",
"city": "MC LEAN",
"state": "VA",
"postal_code": "221024813",
"telephone_number": "202-290-0356"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEPHAN",
"first_name": "CARLA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-04-12",
"last_updated": "2017-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "ZZ",
"license": "4804",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in MC Lean, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.