MEDICARE: DR. ANIL KUMAR VUGGAM D.M.D

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	1223G0001X	General Practice Dentistry	DN1855481	MA

General Provider Information

NPI Number	:	1295047140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANIL KUMAR VUGGAM D.M.D

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	:	857-205-5176
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	:	857-205-5176
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2010
Last Update Date	:	01/22/2026

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