Healthcare Provider Details

I. General information

NPI: 1023977253
Provider Name (Legal Business Name): ANIL VUGGAM PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2026
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11868 SUNRISE VALLEY DR STE 100
RESTON VA
20191-3320
US

IV. Provider business mailing address

11868 SUNRISE VALLEY DR STE 100
RESTON VA
20191-3320
US

V. Phone/Fax

Practice location:
  • Phone: 703-373-0333
  • Fax:
Mailing address:
  • Phone: 703-373-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: ANIL VUGGAM
Title or Position: DENTIST
Credential: DMD
Phone: 857-205-5176