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General NPI Number Information
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NPI Number | 1265840938
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Entity Type | Organization
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Legal Business Name | GREENWAY SMILES FAMILY DENTISTRY
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Dates
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Enumeration Date | 07/25/2014
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Last Update Date | 07/25/2014
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Provider Practice Location Address
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Address Line | 43490 YUKON DR STE. 114
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City | ASHBURN
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State | VA
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Zip | 20147-6990
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Country | US
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Telephone | 571-222-4243
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Fax | 571-248-7400
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Provider Business Mailing Address
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Address Line | 43490 YUKON DR STE. 114
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City | ASHBURN
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State | VA
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Zip | 20147-6990
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Country | US
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Telephone | 571-222-4243
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Fax | 571-248-7400
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SREEPREETHI GNANASUNDARAM
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Credential | D.D.S.
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Telephone | 571-222-4243
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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 | 0401412993
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License Number State | VA
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