Healthcare Provider Details

I. General information

NPI: 1710004304
Provider Name (Legal Business Name): KALAMABYI T KABASELA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8380 COLESVILLE RD SUITE 750
SILVER SPRING MD
20910-6255
US

IV. Provider business mailing address

8380 COLESVILLE RD SUITE 750
SILVER SPRING MD
20910-6255
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 Number8550
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number4303
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: