Provider Demographics
NPI:1346478575
Name:KANUMILLI, SOWMYA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SOWMYA
Middle Name:
Last Name:KANUMILLI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24600 MILLSTREAM DR STE 470
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-5686
Mailing Address - Country:US
Mailing Address - Phone:703-327-9222
Mailing Address - Fax:703-327-9211
Practice Address - Street 1:24600 MILLSTREAM DR STE 470
Practice Address - Street 2:
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-5686
Practice Address - Country:US
Practice Address - Phone:703-327-9222
Practice Address - Fax:703-327-9211
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18551821223G0001X
VA04014126991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice