Provider Demographics
NPI:1831671353
Name:SACHIN RASTOGI DMD PLLC
Entity Type:Organization
Organization Name:SACHIN RASTOGI DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SACHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RASTOGI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:571-310-1191
Mailing Address - Street 1:6001 CLAMES DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-2607
Mailing Address - Country:US
Mailing Address - Phone:781-354-7477
Mailing Address - Fax:
Practice Address - Street 1:6116 ROLLING RD STE 304
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1512
Practice Address - Country:US
Practice Address - Phone:571-310-1191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014158191223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty