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General NPI Number Information
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NPI Number | 1992087993
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Entity Type | Organization
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Legal Business Name | NIRMAL BOGOLLAGAMA, DDS, PC. INC.
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Dates
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Enumeration Date | 09/15/2011
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Last Update Date | 09/15/2011
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Provider Practice Location Address
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Address Line | 623 GARRISONVILLE RD
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City | STAFFORD
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State | VA
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Zip | 22554-3710
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Country | US
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Telephone | 540-659-6650
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Fax |
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Provider Business Mailing Address
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Address Line | 8023 LEWINSVILLE RD
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City | MC LEAN
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State | VA
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Zip | 22102-2435
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Country | US
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Telephone | 202-491-7306
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. NIRMAL BOGOLLAGAMA
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Credential | DDS
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Telephone | 202-491-7306
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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 | 0401410789
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License Number State | VA
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