Ridgetop Dental Of Reston, PLLC
Clinic/Center, Dental in Reston, VA. Organization (NPI-2).
NPI number1295598985
StatusActive
Last updated in NPPESFeb 5, 2024
Details
- NPI
- 1295598985
- Entity type
- Organization (NPI-2)
- Legal business name
- Ridgetop Dental Of Reston, PLLC
- Organization subpart
- No
- Enumeration date
- Feb 5, 2024
- Certification date
- Feb 5, 2024
- Last updated
- Feb 5, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Practice location
1939 Roland Clarke Pl Ste 120Reston, VA 20191-1445
Phone 571-313-0607
Mailing address
1939 Roland Clarke Pl Ste 120Reston, VA 20191-1445
Phone 571-313-0607
Authorized official
Dattathri Malyavantham
Owner
5713130607
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