Healthcare Provider Details

I. General information

NPI: 1770912560
Provider Name (Legal Business Name): NATASHA KHURANA DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 11/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7915 LAKE MANASSAS DR SUITE 301
GAINESVILLE VA
20155-3258
US

IV. Provider business mailing address

7915 LAKE MANASSAS DR SUITE 301
GAINESVILLE VA
20155-3258
US

V. Phone/Fax

Practice location:
  • Phone: 571-248-1501
  • Fax: 703-563-9237
Mailing address:
  • Phone: 571-248-1501
  • Fax: 703-563-9237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401413436
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401412461
License Number StateVA

VIII. Authorized Official

Name: DR. NATASHA KHURANA
Title or Position: OWNER, PEDIATRIC DENTIST
Credential: DDS
Phone: 571-248-1501