Provider Demographics
NPI:1497033302
Name:SANKEPALLY, DIVYA R (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIVYA
Middle Name:R
Last Name:SANKEPALLY
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 1:410 PINE ST SE STE 100
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4861
Mailing Address - Country:US
Mailing Address - Phone:703-938-1415
Mailing Address - Fax:
Practice Address - Street 1:410 PINE ST SE STE 100
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4861
Practice Address - Country:US
Practice Address - Phone:703-938-1415
Practice Address - Fax:703-255-0295
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014131651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice