Provider Demographics
NPI:1124115761
Name:KORI, SHEELA (DDS)
Entity type:Individual
Prefix:
First Name:SHEELA
Middle Name:
Last Name:KORI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SHEELA
Other - Middle Name:KORI
Other - Last Name:VIRUPANNAVAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2200 OPITZ BLVD STE 395
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3350
Mailing Address - Country:US
Mailing Address - Phone:703-491-7695
Mailing Address - Fax:703-490-0444
Practice Address - Street 1:2200 OPITZ BLVD STE 395
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3350
Practice Address - Country:US
Practice Address - Phone:703-491-7695
Practice Address - Fax:703-490-0444
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0268411223G0001X
VA0401412649122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice