DANIEL M THEBERGE (NPI# 1659394443) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659394443 |
| Entity Type | Individual |
| Full Name | DANIEL M THEBERGE |
| Credential | D.D.S. |
| Practice Address |
10530 Rosehaven St Suite 111 Fairfax VA 22030-2840 |
| Practice Telephone | 7033855777 |
| Practice Fax Number | 7035915386 |
| Mailing Telephone | 7033855777 |
| Mailing Fax Number | 7035915386 |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
0401008197 | VA | Dental Providers |
| Street Address |
10530 ROSEHAVEN ST SUITE 111 |
| City | FAIRFAX |
| State | VA |
| Zip Code | 22030-2840 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316967862 | Henry W. Zussman | Dentist | 10530 Rosehaven St, Suite 111, Fairfax, VA 22030-2840 | 2006-07-20 |
| 1144509258 | Justin A Baker | Dentist | 10530 Rosehaven St, Suite 111, Fairfax, VA 22030-2840 | 2011-08-07 |
| 1932337185 | Ramon Raymond Blanco | Family Medicine | 10530 Rosehaven St, Suite 100, Fairfax, VA 22030-2840 | 2009-06-26 |
| 1154565653 | John Hyun Hur | Dentist | 10530 Rosehaven St, Suite 111, Fairfax, VA 22030-2840 | 2009-04-28 |
| 1336386325 | Frederick Liu | Dentist | 10530 Rosehaven St, Suite 111, Fairfax, VA 22030-2840 | 2009-01-13 |
| 1831399096 | Cyrus A Ramsey | Dentist | 10530 Rosehaven St, Fairfax, VA 22030-2840 | 2007-07-24 |
| 1790795466 | Kimberly A Silloway | Dentist | 10530 Rosehaven St, Suite 111, Fairfax, VA 22030-2840 | 2006-08-08 |
| 1760406805 | Patrick J Dolan | Dentist | 10530 Rosehaven St, Suite 111, Fairfax, VA 22030-2840 | 2006-07-26 |
| 1114940905 | Jonathan J Park | Dentist | 10530 Rosehaven St, Suite 111, Fairfax, VA 22030-2840 | 2006-07-25 |
| 1811910631 | Peter W. Smith | Dentist | 10530 Rosehaven St, Suite 111, Fairfax, VA 22030-2840 | 2006-07-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205449477 | Perry Camp Jr. | Psychologist | 4403 Dixie Hill Rd, Unit 205, Fairfax, VA 22030 | 2020-08-28 |
| 1952940322 | Brightview Fair Oaks, LLC | Alzheimer Center (Dementia Center) | 12725 Lee Highway, Fairfax, VA 22030 | 2020-01-02 |
| 1245871524 | Tori Sprowl | Behavioral Analyst | 10430 Democracy Lane #102b & 103, Fairfax, VA 22030 | 2019-10-08 |
| 1528612124 | Paul Sarigianis | Student in an Organized Health Care Education/Training Program | 10379b Democracy Lane, Fairfax, VA 22030 | 2019-07-31 |
| 1497221303 | Kahak, Inc. | Day Training, Developmentally Disabled Services | 10560 Main Street Suite Ps100, Fairfax, VA 22030 | 2018-10-17 |
| 1689177073 | Shamoona Sharif | Dentist | 11050 Lee Hwy, Fairfax, VA 22030 | 2018-03-13 |
| 1205339538 | Rachael Lee Greene | Social Worker | 4403 Dixie Hill Rd. #206, Fairfax, VA 22030 | 2018-03-13 |
| 1558863027 | Jacqueline Renee Bauer | Skilled Nursing Facility | 10701 Main Street, Fairfax, VA 22030 | 2018-03-01 |
| 1275033607 | Philajo Global LLC | Non-emergency Medical Transport (VAN) | 4521 Billingham Street, Fairfax, VA 22030 | 2018-02-12 |
| 1376050401 | Alexander Harrison | Counselor | 4400 University Drive, Ms 2a2, Fairfax, VA 22030 | 2018-01-10 |
| Find all providers in zip 22030 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831418714 | Patrick R Friend | Dentist | 10530 Rosehaven St Ste 111, Fairfax, VA 22030-2840 | 2010-05-18 |
| 1376700427 | Huy Chi Trinh | Dentist | 4211 Fairfax Corner Ave E Ste 235, Fairfax, VA 22030-8623 | 2008-05-16 |
| 1336347038 | Basil Arthur Schiff | Dentist | 3050 Chain Bridge Rd, Suite 205, Fairfax, VA 22030-2834 | 2007-07-05 |
| 1316967862 | Henry W. Zussman | Dentist | 10530 Rosehaven St, Suite 111, Fairfax, VA 22030-2840 | 2006-07-20 |
| 1063825677 | Daniel Winokur | Dentist | 10530 Rosehaven St Ste 111, Fairfax, VA 22030-2840 | 2014-06-11 |
| 1639599376 | Justin Lee Nguyen | Dentist | 10530 Rosehaven St Ste 111, Fairfax, VA 22030-2840 | 2014-04-21 |
| 1144509258 | Justin A Baker | Dentist | 10530 Rosehaven St, Suite 111, Fairfax, VA 22030-2840 | 2011-08-07 |
| 1154565653 | John Hyun Hur | Dentist | 10530 Rosehaven St, Suite 111, Fairfax, VA 22030-2840 | 2009-04-28 |
| 1336386325 | Frederick Liu | Dentist | 10530 Rosehaven St, Suite 111, Fairfax, VA 22030-2840 | 2009-01-13 |
| 1831399096 | Cyrus A Ramsey | Dentist | 10530 Rosehaven St, Fairfax, VA 22030-2840 | 2007-07-24 |
| Find all providers in FAIRFAX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.