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General NPI Number Information
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NPI Number | 1316249501
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Entity Type | Organization
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Legal Business Name | SHAMIK S. VAKIL, DDS, MS, PLLC
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Dates
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Enumeration Date | 11/22/2010
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Last Update Date | 11/22/2010
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Provider Practice Location Address
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Address Line | 46175 WESTLAKE DR SUITE 430
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City | STERLING
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State | VA
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Zip | 20165-5873
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Country | US
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Telephone | 703-430-8215
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Fax |
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Provider Business Mailing Address
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Address Line | 46175 WESTLAKE DR STE 430
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City | STERLING
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State | VA
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Zip | 20165-5886
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SHAMIK SURESH VAKIL
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Credential | DDS
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Telephone | 703-430-5417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 0401412253
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License Number State | VA
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