MEDICARE: SHIRLINGTON PEDIATRIC DENTISTRY

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	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1598418667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIRLINGTON PEDIATRIC DENTISTRY

Provider Business Mailing Address
First Line	:	3501 FARM HILL DR
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-1238
Country	:	US
Telephone Number	:	703-646-1805
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 S QUINCY ST STE 305
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22206-2242
Country	:	US
Telephone Number	:	703-646-1805
Fax Number	:

Authorized Official
Title or Position	:	PEDIATRIC DENTIST
Name	:	DR. SHWETHA RAI
Credential	:	DDS
Telephone Number	:	703-646-1805

Provider Enumeration Date	:	01/30/2022
Last Update Date	:	01/30/2022

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