Healthcare Provider Details

I. General information

NPI: 1699681791
Provider Name (Legal Business Name): ANKUR BANSAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 HIGH ST STE A
WALDORF MD
20602-2191
US

IV. Provider business mailing address

150 I ST SE APT 1023
WASHINGTON DC
20003-4997
US

V. Phone/Fax

Practice location:
  • Phone: 301-645-3601
  • Fax:
Mailing address:
  • Phone: 248-376-2954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18956
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: