Provider Demographics
NPI:1639426760
Name:SASTRY, PREETI K (DDS)
Entity type:Individual
Prefix:
First Name:PREETI
Middle Name:K
Last Name:SASTRY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WEST BROADDUS AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOWLING GREEN
Mailing Address - State:VA
Mailing Address - Zip Code:22427
Mailing Address - Country:US
Mailing Address - Phone:804-632-1030
Mailing Address - Fax:
Practice Address - Street 1:102 WEST BROADDUS AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:BOWLING GREEN
Practice Address - State:VA
Practice Address - Zip Code:22427
Practice Address - Country:US
Practice Address - Phone:804-632-1030
Practice Address - Fax:804-632-1033
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014136011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice