Healthcare Provider Details

I. General information

NPI: 1508001314
Provider Name (Legal Business Name): SAXENA DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552 FORT EVANS RD SUITE 100
LEESBURG VA
20176-4098
US

IV. Provider business mailing address

552 FORT EVANS RD SUITE 100
LEESBURG VA
20176-4098
US

V. Phone/Fax

Practice location:
  • Phone: 703-771-9494
  • Fax:
Mailing address:
  • Phone: 703-771-9494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number0401410456
License Number StateVA

VIII. Authorized Official

Name: DR. CHETANA ANNE SAXENA
Title or Position: C.E.O
Credential: D.M.D.
Phone: 703-771-9494