Organization
PRINCE WILLIAM DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MADHUSUDHAN REDDY KASIPATHY DDS (DENTIST/ OWNER)
(848) 667-0516
Entity
Organization
Contact information
Practice address
7051 HEATHCOTE VILLAGE WAY STE 100, GAINESVILLE, VA 20155-3197
(848) 667-0516
Mailing address
43313 BARNSTEAD DR, ASHBURN, VA 20148-6890
(848) 667-0516
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1316100639
MADHUSUDHAN KASIPATHY
VA
01
—
1750583738
KOWSHIK VADDI
VA
Enumeration date
05/19/2020
Last updated
05/19/2020
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