Healthcare Provider Details

I. General information

NPI: 1336984624
Provider Name (Legal Business Name): OJASWI SHRESTHA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14337 NEWBROOK DR STE 200
CHANTILLY VA
20151-4259
US

IV. Provider business mailing address

4869 LANGER LN
WOODBRIDGE VA
22193-4344
US

V. Phone/Fax

Practice location:
  • Phone: 703-214-2113
  • Fax:
Mailing address:
  • Phone: 630-456-5665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401419029
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: