MEDICARE: ANIL VUGGAM PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1023977253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANIL VUGGAM PLLC

Provider Business Mailing Address
First Line	:	11868 SUNRISE VALLEY DR STE 100
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20191-3320
Country	:	US
Telephone Number	:	703-373-0333
Fax Number	:

Provider Business Practice Location Address
First Line	:	11868 SUNRISE VALLEY DR STE 100
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20191-3320
Country	:	US
Telephone Number	:	703-373-0333
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	ANIL VUGGAM
Credential	:	DMD
Telephone Number	:	857-205-5176

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	01/22/2026

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