MEDICARE: DR. ALKA PANWAR DDS

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	1223P0300X	Periodontics	0401416701	VA

General Provider Information

NPI Number	:	1689223836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALKA PANWAR DDS

Provider Business Mailing Address
First Line	:	8030 CRIANZA PL APT 141
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-4092
Country	:	US
Telephone Number	:	347-530-4870
Fax Number	:

Provider Business Practice Location Address
First Line	:	4319 DALE BLVD STE 6
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-2401
Country	:	US
Telephone Number	:	703-897-8554
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2019
Last Update Date	:	09/10/2019

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