Healthcare Provider Details

I. General information

NPI: 1790634889
Provider Name (Legal Business Name): RAM DINESH KUSHWAHA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208B ELM AVE
LOUISA VA
23093-6578
US

IV. Provider business mailing address

837 PARKLAND PL
GLEN ALLEN VA
23059-5681
US

V. Phone/Fax

Practice location:
  • Phone: 540-967-0777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401420302
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: