Provider Demographics
NPI:1578399648
Name:WEE SMILE DENTAL PLLC
Entity type:Organization
Organization Name:WEE SMILE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:
Authorized Official - First Name:ANNAPURNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BONDALAPATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-760-0139
Mailing Address - Street 1:6101 REDWOOD SQUARE CTR STE 300
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-4269
Mailing Address - Country:US
Mailing Address - Phone:919-760-0139
Mailing Address - Fax:
Practice Address - Street 1:6101 REDWOOD SQUARE CTR STE 300
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-4269
Practice Address - Country:US
Practice Address - Phone:919-760-0139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental