Provider Demographics
NPI:1396057410
Name:PUNAJI, SOWMYA N (DDS)
Entity type:Individual
Prefix:
First Name:SOWMYA
Middle Name:N
Last Name:PUNAJI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12739 DIRECTORS LOOP
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-1253
Mailing Address - Country:US
Mailing Address - Phone:703-494-4490
Mailing Address - Fax:703-494-6650
Practice Address - Street 1:12739 DIRECTORS LOOP
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2461
Practice Address - Country:US
Practice Address - Phone:703-494-4490
Practice Address - Fax:203-709-7750
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413658122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist