Healthcare Provider Details

I. General information

NPI: 1619872710
Provider Name (Legal Business Name): SAIDHEERAJ PARVATANENI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233362 LONGOLLEN WOODS TERRACE
ASHBURN VA
20148
US

IV. Provider business mailing address

233362 LONGOLLEN WOODS TERRACE
ASHBURN VA
20148
US

V. Phone/Fax

Practice location:
  • Phone: 571-385-5595
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401420253
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: