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General NPI Number Information
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NPI Number | 1114797560
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Entity Type | Organization
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Legal Business Name | AMOGA DENTAL PLLC
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Dates
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Enumeration Date | 01/08/2024
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 44790 MAYNARD SQ STE 180
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City | ASHBURN
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State | VA
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Zip | 20147-6515
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Country | US
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Telephone | 617-797-2710
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Fax |
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Provider Business Mailing Address
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Address Line | 801 SHERLIN LN
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City | GREAT FALLS
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State | VA
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Zip | 22066-1358
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Country | US
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Telephone | 617-797-2710
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. YAMUNA DEVI SUBRAMANIAN
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Credential | DMD
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Telephone | 617-797-2710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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