Provider Demographics
NPI:1760692511
Name:KRISHNAMOORTHY, SAVITHA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAVITHA
Middle Name:
Last Name:KRISHNAMOORTHY
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 1:42463 LONGACRE DR
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-6382
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5960 KINGSTOWNE TOWNE CTR STE 140
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5897
Practice Address - Country:US
Practice Address - Phone:703-719-9210
Practice Address - Fax:703-719-6330
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014109821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice