Healthcare Provider Details

I. General information

NPI: 1942409065
Provider Name (Legal Business Name): JULIE LIN BAVEJA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14102 ROBERT PARIS CT
CHANTILLY VA
20151-4205
US

IV. Provider business mailing address

14102 ROBERT PARIS CT
CHANTILLY VA
20151-4205
US

V. Phone/Fax

Practice location:
  • Phone: 703-870-7370
  • Fax: 703-349-7300
Mailing address:
  • Phone: 703-870-7370
  • Fax: 703-349-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401412085
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: