12000 Wyndham Lake Dr, Ste C, Glen Allen, VA 23059
Phone
(804) 364-8366
Listed under
Individual orthodontists
NPI
1013914654
NPI status
Active in the NPPES registry
Provider type
Individual provider
Registered specialty (self-reported taxonomy)
Orthodontics and Dentofacial Orthopedics (1223X0400X)
Credentials listed
DDS
License number on NPI record
0401410390 (VA)
NPI first issued
Jun 28, 2005
NPI record last updated
Jul 13, 2026
NPI 1013914654 is active in the federal NPPES registry (CMS) with Orthodontics and Dentofacial Orthopedics, an ADA-recognized dental specialty, as its primary taxonomy; license 0401410390 (VA) is listed on the record. Source: NPPES NPI Registry (CMS) (record). Data as of 2026-09-30.
What these registry facts mean
The NPI (National Provider Identifier) is the federal ID every HIPAA-covered provider uses to bill insurance. This NPI belongs to an individual clinician. The specialty is the taxonomy the provider chose when registering; NPPES does not check it. A license number here is what the provider entered — confirm it with the state board before you rely on it. Orthodontists are dentists who completed an accredited orthodontic residency after dental school. General dentists can also offer braces or aligners, but they are not listed here.
Checking credentials: the specialty shown is the one this provider registered with the NPI system. Your state dental board's license lookup confirms the license, and the American Board of Orthodontics lists board-certified orthodontists.