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General NPI Number Information
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NPI Number | 1972996114
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Entity Type | Organization
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Legal Business Name | KISHORE THAMMINENI DENTAL ASSOCIATES DDS PC
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Dates
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Enumeration Date | 03/12/2015
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Last Update Date | 03/12/2015
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Provider Practice Location Address
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Address Line | 20876 ISHERWOOD TER APT 101
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City | ASHBURN
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State | VA
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Zip | 20147-7788
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Country | US
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Telephone | 305-942-3458
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Fax | 540-773-3284
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Provider Business Mailing Address
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Address Line | 1330 AMHERST ST STE B
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City | WINCHESTER
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State | VA
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Zip | 22601-3000
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Country | US
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Telephone | 305-942-3458
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Fax | 540-773-3284
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Authorized Official
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Title or Position | OWNER
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Name | DR. KISHORE BABU THAMMINENI
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Credential | DDS
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Telephone | 305-942-3458
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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 | 0401414079
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License Number State | VA
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