Provider Demographics
NPI:1255832234
Name:PRIME FAMILY DENTISTRY, PLLC
Entity Type:Organization
Organization Name:PRIME FAMILY DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUBHA
Authorized Official - Middle Name:C
Authorized Official - Last Name:YERABOLLU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-403-1304
Mailing Address - Street 1:22917 EMERALD CHASE PL
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-6446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24805 PINEBROOK RD # 316
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-4126
Practice Address - Country:US
Practice Address - Phone:703-403-1304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental