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NPI Code Detail

MEDICARE: DR. SANGEETHA K BHASAVRAJU DDS

MEDICARE: DR. SANGEETHA K BHASAVRAJU DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistDEN1001397DC

General Provider Information

NPI Number : 1346589595
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SANGEETHA K BHASAVRAJU DDS
Provider Business Mailing Address
First Line : 13209 ASHNUT LN
Second Line :
City : HERNDON
State : VA
Zip : 20171-4308
Country : US
Telephone Number : 703-953-1652
Fax Number :
Provider Business Practice Location Address
First Line : 6428 GEORGIA AVE NW
Second Line :
City : WASHINGTON
State : DC
Zip : 20012-2910
Country : US
Telephone Number : 312-274-4520
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2013
Last Update Date : 11/18/2019

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