Provider Demographics
NPI:1730503970
Name:VEMULA, ROJA (DDS)
Entity type:Individual
Prefix:
First Name:ROJA
Middle Name:
Last Name:VEMULA
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 1:107 E HOLLY AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-5405
Mailing Address - Country:US
Mailing Address - Phone:703-430-6655
Mailing Address - Fax:703-430-6684
Practice Address - Street 1:107 E HOLLY AVE STE 5
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-5405
Practice Address - Country:US
Practice Address - Phone:703-430-6655
Practice Address - Fax:703-430-6684
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190305001223G0001X
VA04014150801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice