Healthcare Provider Details

I. General information

NPI: 1407604200
Provider Name (Legal Business Name): MS. PRIYANKA KALOTRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 CHEVY CHASE DR STE 101
LAUREL MD
20707-2995
US

IV. Provider business mailing address

6100 CHEVY CHASE DR STE 101
LAUREL MD
20707-2995
US

V. Phone/Fax

Practice location:
  • Phone: 301-725-0131
  • Fax:
Mailing address:
  • Phone: 301-725-0131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18583
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: