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General NPI Number Information
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NPI Number | 1871695650
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Entity Type | Organization
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Legal Business Name | S. RAI. DDS.,P.C.
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 239 GARRISONVILLE RD 102
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City | STAFFORD
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State | VA
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Zip | 22554-1554
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Country | US
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Telephone | 540-657-0867
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Fax |
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Provider Business Mailing Address
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Address Line | 239 GARRISONVILLE RD 102
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City | STAFFORD
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State | VA
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Zip | 22554-1554
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Country | US
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Telephone | 540-657-0867
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHIVAPRASANNA RAI
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Credential | DDS
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Telephone | 540-657-0867
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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 | 0401007933
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License Number State | VA
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