Healthcare Provider Details

I. General information

NPI: 1770901324
Provider Name (Legal Business Name): NAVEEN KWATRA, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 W DIAMOND AVE SUITE 250
GAITHERSBURG MD
20878-1415
US

IV. Provider business mailing address

806 W DIAMOND AVE SUITE 250
GAITHERSBURG MD
20878-1415
US

V. Phone/Fax

Practice location:
  • Phone: 301-977-2200
  • Fax:
Mailing address:
  • Phone: 301-977-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. NAVEEN KWATRA
Title or Position: PRESIDENT/OWNER
Credential: DDS
Phone: 301-977-2200