Provider Demographics
NPI:1285293746
Name:DENICOLA KHANNA DDS, PLLC
Entity type:Organization
Organization Name:DENICOLA KHANNA DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-432-6616
Mailing Address - Street 1:1451 BROOKHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3584
Mailing Address - Country:US
Mailing Address - Phone:540-432-6616
Mailing Address - Fax:540-432-6618
Practice Address - Street 1:1451 BROOKHAVEN DR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-3584
Practice Address - Country:US
Practice Address - Phone:540-432-6616
Practice Address - Fax:540-432-6618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental