Provider Demographics
NPI:1235562901
Name:WANSI, LINDA BRENDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LINDA BRENDA
Middle Name:
Last Name:WANSI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17333 PICKWICK DR STE A&B
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-6173
Mailing Address - Country:US
Mailing Address - Phone:404-417-6275
Mailing Address - Fax:
Practice Address - Street 1:17333 PICKWICK DR STE A&B
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-6173
Practice Address - Country:US
Practice Address - Phone:540-441-7627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94861223P0221X
VA04014139681223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1235562901Medicaid