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1265884423 NPI number — RESTON FAMILY DENTIST GROUP PLLC

NPI Number: 1265884423
Health Care Provider/Practitioner: RESTON FAMILY DENTIST GROUP PLLC

Information about “1265884423” NPI (RESTON FAMILY DENTIST GROUP PLLC) exists in 1265884423 in HTML format HTML  |  1265884423 in plain Text format TXT  |  1265884423 in PDF (Portable Document Format) PDF  |  1265884423 in an XML format XML  formats.

NPI Number : 1265884423 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1265884423",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "RESTON FAMILY DENTIST GROUP PLLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "12025 TOWN SQUARE ST",
    "SecondLineMailingAddress": "UNIT 424",
    "MailingAddressCityName": "RESTON",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "20190-6026",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "571-423-7945",
    "MailingAddressFaxNumber": "571-313-0576",
    "FirstLinePracticeLocationAddress": "1801 ROBERT FULTON DR",
    "SecondLinePracticeLocationAddress": "SUITE 100",
    "PracticeLocationAddressCityName": "RESTON",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "20191-5461",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "571-423-7945",
    "PracticeLocationAddressFaxNumber": "571-313-0576",
    "EnumerationDate": "07/12/2016",
    "LastUpdateDate": "07/12/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MIAMEE",
    "AuthorizedOfficialFirstName": "ALI",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DDS",
    "AuthorizedOfficialTelephoneNumber": "571-423-7945",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "1223P0300X",
          "TaxonomyName": "Periodontics",
          "LicenseNumber": "0401412603",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1223G0001X",
          "TaxonomyName": "General Practice Dentistry",
          "LicenseNumber": "0401412603",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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