Organization
RIDGETOP DENTAL OF RESTON, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DATTATHRI MALYAVANTHAM DDS (OWNER)
(571) 313-0607
Entity
Organization
Contact information
Practice address
1939 ROLAND CLARKE PL STE 120, RESTON, VA 20191-1445
(571) 313-0607
Mailing address
1939 ROLAND CLARKE PL STE 120, RESTON, VA 20191-1445
(571) 313-0607
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
02/05/2024
Last updated
02/05/2024
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