Provider Demographics
NPI:1265840938
Name:GREENWAY SMILES FAMILY DENTISTRY
Entity Type:Organization
Organization Name:GREENWAY SMILES FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SREEPREETHI
Authorized Official - Middle Name:
Authorized Official - Last Name:GNANASUNDARAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:571-222-4243
Mailing Address - Street 1:43490 YUKON DR
Mailing Address - Street 2:STE. 114
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-6990
Mailing Address - Country:US
Mailing Address - Phone:571-222-4243
Mailing Address - Fax:571-248-7400
Practice Address - Street 1:43490 YUKON DR
Practice Address - Street 2:STE. 114
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6990
Practice Address - Country:US
Practice Address - Phone:571-222-4243
Practice Address - Fax:571-248-7400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014129931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty