Individual
SOUMYATA MANJUNATHA HEGGADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
7227 COMMERCE ST, SPRINGFIELD, VA 22150-3411
(703) 992-7778
Mailing address
7227 COMMERCE ST, SPRINGFIELD, VA 22150-3411
(703) 992-7778
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401413726
VA
1223G0001X
General Practice Dentistry
0401413726
VA
Other
Enumeration date
09/19/2012
Last updated
09/03/2024
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