Provider Demographics
NPI:1821124298
Name:SARAVANA, SAUMITRA (DMD)
Entity Type:Individual
Prefix:
First Name:SAUMITRA
Middle Name:
Last Name:SARAVANA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 GARRISONVILLE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-1542
Mailing Address - Country:US
Mailing Address - Phone:540-288-9212
Mailing Address - Fax:540-288-5257
Practice Address - Street 1:315 GARRISONVILLE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1542
Practice Address - Country:US
Practice Address - Phone:540-288-9212
Practice Address - Fax:540-288-5257
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014110381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice