Healthcare Provider Details

I. General information

NPI: 1285458646
Provider Name (Legal Business Name): PVS DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46400 BENEDICT DR STE 109
STERLING VA
20164-6605
US

IV. Provider business mailing address

46400 BENEDICT DR STE 109
STERLING VA
20164-6605
US

V. Phone/Fax

Practice location:
  • Phone: 703-444-3412
  • Fax:
Mailing address:
  • Phone: 703-444-3412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. PAVANI GEDELA
Title or Position: GENERAL DENTIST
Credential: DDS
Phone: 415-889-3003