Provider Demographics
NPI:1518723766
Name:OPULENT PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:OPULENT PEDIATRIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRIYANKA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-354-0511
Mailing Address - Street 1:5882 MONET DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-5237
Mailing Address - Country:US
Mailing Address - Phone:540-354-0511
Mailing Address - Fax:
Practice Address - Street 1:105 AKERS FARM RD
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-4864
Practice Address - Country:US
Practice Address - Phone:540-394-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty