Provider Demographics
NPI:1790910859
Name:REJINTALA, ARCHANA R
Entity Type:Individual
Prefix:DR
First Name:ARCHANA
Middle Name:R
Last Name:REJINTALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41646 BOSTONIAN PL
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-5648
Mailing Address - Country:US
Mailing Address - Phone:904-566-6549
Mailing Address - Fax:
Practice Address - Street 1:24805 PINEBROOK RD STE 212
Practice Address - Street 2:
Practice Address - City:SOUTH RIDING
Practice Address - State:VA
Practice Address - Zip Code:20152-4128
Practice Address - Country:US
Practice Address - Phone:904-566-6549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA390200000X
VA04014126641223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program