Healthcare Provider Details

I. General information

NPI: 1689389314
Provider Name (Legal Business Name): KALAMBAYI T KABASELA DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8380 COLESVILLE ROAD SUITE 750
SILVER SPRING MD
20910
US

IV. Provider business mailing address

8380 COLESVILLE ROAD SUITE 750
SILVER SPRING MD
20910
US

V. Phone/Fax

Practice location:
  • Phone: 301-585-0405
  • Fax: 301-585-0512
Mailing address:
  • Phone: 301-585-0405
  • Fax: 301-585-0512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: KALAMBAYI T KABASELA
Title or Position: OWNER
Credential: D.D.S.
Phone: 301-585-0405