MEDICARE: CHAD KASPEROWSKI, DMD, PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	411416	VA

General Provider Information

NPI Number	:	1255634788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAD KASPEROWSKI, DMD, PLC

Provider Business Mailing Address
First Line	:	11200 LEE HWY
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-5045
Country	:	US
Telephone Number	:	703-591-5637
Fax Number	:	703-591-7934

Provider Business Practice Location Address
First Line	:	11200 LEE HWY
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-5045
Country	:	US
Telephone Number	:	703-591-5637
Fax Number	:	703-591-7934

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. CHAD ALAN KASPEROWSKI
Credential	:	D.M.D.
Telephone Number	:	703-591-5637

Provider Enumeration Date	:	12/06/2010
Last Update Date	:	12/06/2010

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