Individual
MR. NIRMAL CUDA BOGOLLAGAMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
10751 AMBASSADOR DR # 101, MANASSAS, VA 20109-2627
(703) 369-6969
Mailing address
10751 AMBASSADOR DR # 101, MANASSAS, VA 20109-2627
(703) 369-6969
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401410789
VA
1223G0001X
General Practice Dentistry
0401410789
VA
Other
Enumeration date
11/11/2009
Last updated
11/11/2009
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