| Blue Ridge Pediatric Dentistry | |
|
46175 Westlake Dr Suite 430 Sterling VA 20165-5873 | |
| (703) 430-8215 | |
| Not Available |
| Full Name | Blue Ridge Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 46175 Westlake Dr, Sterling, Virginia |
| Authorized Official Name and Position | Shamik Suresh Vakil (DENTIST) |
| Authorized Official Contact | 7034305417 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Ridge Pediatric Dentistry 46175 Westlake Dr Ste 430 Sterling VA 20165-5886 Ph: () - | Blue Ridge Pediatric Dentistry 46175 Westlake Dr Suite 430 Sterling VA 20165-5873 Ph: (703) 430-8215 |
| NPI Number | 1316249501 |
|---|---|
| Provider Enumeration Date | 11/22/2010 |
| Last Update Date | 11/22/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316249501 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 0401412253 (Virginia) | Primary |
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