Healthcare Provider Details

I. General information

NPI: 1114797560
Provider Name (Legal Business Name): AMOGA DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46519 LEESBURG PIKE STE 145
STERLING VA
20164-3577
US

IV. Provider business mailing address

801 SHERLIN LN
GREAT FALLS VA
22066-1358
US

V. Phone/Fax

Practice location:
  • Phone: 571-496-0095
  • Fax: 346-509-6074
Mailing address:
  • Phone: 617-797-2710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. YAMUNA DEVI SUBRAMANIAN
Title or Position: GENERAL DENTIST
Credential: DMD
Phone: 617-797-2710