Provider Demographics
NPI:1538822663
Name:SMILELINE DENTAL PC
Entity type:Organization
Organization Name:SMILELINE DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SANGEETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BHASAVRAJU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:571-512-6099
Mailing Address - Street 1:106 ELDEN ST STE 18
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4826
Mailing Address - Country:US
Mailing Address - Phone:571-512-6099
Mailing Address - Fax:
Practice Address - Street 1:106 ELDEN ST STE 18
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4826
Practice Address - Country:US
Practice Address - Phone:571-512-6099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental