Provider Demographics
NPI:1750583738
Name:VADDI, KOWSHIK R (DMD)
Entity type:Individual
Prefix:DR
First Name:KOWSHIK
Middle Name:R
Last Name:VADDI
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 1:13080 ROSE PETAL CIR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-4825
Mailing Address - Country:US
Mailing Address - Phone:774-212-3828
Mailing Address - Fax:
Practice Address - Street 1:8353 GREENSBORO DR
Practice Address - Street 2:SUITE A & B
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3530
Practice Address - Country:US
Practice Address - Phone:774-212-3828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6215-015122300000X
VA0401414337122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist