Healthcare Provider Details

I. General information

NPI: 1831671353
Provider Name (Legal Business Name): SACHIN RASTOGI DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6116 ROLLING RD STE 304
SPRINGFIELD VA
22152-1512
US

IV. Provider business mailing address

6001 CLAMES DR
ALEXANDRIA VA
22310-2607
US

V. Phone/Fax

Practice location:
  • Phone: 571-310-1191
  • Fax:
Mailing address:
  • Phone: 781-354-7477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number0401415819
License Number StateVA

VIII. Authorized Official

Name: DR. SACHIN RASTOGI
Title or Position: OWNER
Credential: DMD
Phone: 571-310-1191