Renuka Rao, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

0401416536 Issued in VA

Practice address

43170 Southern Walk PLZ Ste 116
Broadlands, VA 20148-4464

Phone

(703) 687-4320

NPI assigned

Jun 9, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560038400000",
    "number": "1871152314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3819 HILLCREST LN",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220032311",
            "telephone_number": "703-994-3638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43170 SOUTHERN WALK PLZ STE 116",
            "city": "BROADLANDS",
            "state": "VA",
            "postal_code": "201484464",
            "telephone_number": "703-687-4320"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9625 Surveyor Ct Ste 101",
            "address_purpose": "LOCATION",
            "city": "Manassas",
            "state": "VA",
            "postal_code": "201104408",
            "country_code": "US",
            "telephone_number": "703-994-3638",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAO",
        "first_name": "RENUKA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-09",
        "last_updated": "2019-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401416536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.broadlandscompletedental.com/",
            "affiliation": "N",
            "endpointDescription": "Dental Office",
            "address_1": "43170 Southern Walk Plz Ste 116",
            "city": "Broadlands",
            "state": "VA",
            "country_code": "US",
            "postal_code": "201484464",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nicolo William Porto, MSW
• Jennifer Lynn Poteat, LCSW
• Stacey Privman
• Kristin Quimby
• Fatima Zahra Rahman-Yu
• Erin Raymond
• Nicholas Raymond
• Nicholas James Razeghi, SLP
• Rejoice Health Co.
• Rejoice Health Inc.

• Dentist in Broadlands, VA
• Providers in Broadlands, VA by specialty
• Dentist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.