Active NPI
Dima Lakkis, DDS
- Periodontics
- Alexandria, VA
National Provider Identifier
1992002075
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 0401413086
- Practice address
- 4660 Kenmore Ave
Alexandria, VA 22304-1313 - Phone
- (793) 823-2228
- Fax
- (703) 823-0663
- NPI assigned
- Feb 25, 2011
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 0401413086 | VA | Primary |
Addresses
Primary practice location
4660 Kenmore Ave
Alexandria, VA 22304-1313
Mailing address
4660 Kenmore Ave
Suite 312
Alexandria, VA 22304
Phone (703) 823-2228
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 Jul 7, 2015 through Jul 7, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401413086 | VA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1298592000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472774400000",
"number": "1992002075",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4660 KENMORE AVE",
"address_2": "SUITE 312",
"city": "ALEXANDRIA",
"state": "VA",
"postal_code": "22304",
"telephone_number": "703-823-2228",
"fax_number": "703-823-0663"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4660 KENMORE AVE",
"city": "ALEXANDRIA",
"state": "VA",
"postal_code": "223041313",
"telephone_number": "793-823-2228",
"fax_number": "703-823-0663"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAKKIS",
"first_name": "DIMA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-02-25",
"last_updated": "2016-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "VA",
"license": "0401413086",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alexandria, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2016; 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.