Provider Demographics
NPI:1316249501
Name:SHAMIK S. VAKIL, DDS, MS, PLLC
Entity type:Organization
Organization Name:SHAMIK S. VAKIL, DDS, MS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAMIK
Authorized Official - Middle Name:SURESH
Authorized Official - Last Name:VAKIL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-430-5417
Mailing Address - Street 1:46175 WESTLAKE DR STE 430
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5886
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:46175 WESTLAKE DR
Practice Address - Street 2:SUITE 430
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-5873
Practice Address - Country:US
Practice Address - Phone:703-430-8215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014122531223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty