Individual
DR. DATTATHRI B MALYAVANTHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
21475 RIDGETOP CIR, SUITE 230, STERLING, VA 20166-6580
(703) 444-9900
Mailing address
21475 RIDGETOP CIR, SUITE 230, STERLING, VA 20166-6580
(703) 444-9900
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
00401410653
VA
Other
Enumeration date
07/31/2006
Last updated
07/08/2007
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