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General NPI Number Information
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NPI Number | 1871152314
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Entity Type | Individual
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Provider Name | RENUKA RAO DMD
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Gender | Female
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Dates
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Enumeration Date | 06/09/2019
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Last Update Date | 06/09/2019
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Provider Practice Location Address
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Address Line | 43170 SOUTHERN WALK PLZ STE 116
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City | BROADLANDS
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State | VA
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Zip | 20148-4464
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Country | US
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Telephone | 703-687-4320
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Fax |
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Provider Business Mailing Address
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Address Line | 3819 HILLCREST LN
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City | ANNANDALE
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State | VA
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Zip | 22003-2311
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Country | US
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Telephone | 703-994-3638
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401416536
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License Number State | VA
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