Individual
VIKAS PURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11150 FAIRFAX BLVD, FAIRFAX, VA 22030-5066
(703) 934-4474
Mailing address
9423 GLENCROFT WAY, INDIANAPOLIS, IN 46250-4150
(260) 416-2125
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
0401413441
VA
Other
Enumeration date
02/18/2012
Last updated
02/18/2012
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