Organization
SMILELINE DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANGEETHA BHASAVRAJU DDS (GENERAL DENTIST)
(571) 512-6099
Entity
Organization
Contact information
Practice address
106 ELDEN ST STE 18, HERNDON, VA 20170-4826
(571) 512-6099
Mailing address
106 ELDEN ST STE 18, HERNDON, VA 20170-4826
(571) 512-6099
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/15/2021
Last updated
10/15/2021
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