Healthcare Provider Details

I. General information

NPI: 1699405886
Provider Name (Legal Business Name): DR. VINEETHA VIJAYAKUMAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2022
Last Update Date: 06/12/2022
Certification Date: 06/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 S COLUMBIA ST
CHAPEL HILL NC
27599-0001
US

IV. Provider business mailing address

13010 CABIN CREEK RD
HERNDON VA
20171
US

V. Phone/Fax

Practice location:
  • Phone: 919-537-3737
  • Fax:
Mailing address:
  • Phone: 571-373-9906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9534
License Number StateZZ
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9534
License Number StateZZ
# 3
Primary TaxonomyN
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License Number9534
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: