Provider Demographics
NPI:1659109056
Name:SITOULA, PRAKRITI (DMD)
Entity type:Individual
Prefix:
First Name:PRAKRITI
Middle Name:
Last Name:SITOULA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2183 MONAGHAN DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4330
Mailing Address - Country:US
Mailing Address - Phone:703-350-3899
Mailing Address - Fax:
Practice Address - Street 1:11700 PLAZA AMERICA DR STE 100
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-4761
Practice Address - Country:US
Practice Address - Phone:571-222-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014190301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice