Healthcare Provider Details

I. General information

NPI: 1942721147
Provider Name (Legal Business Name): SHEENA KHETARPAL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 06/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 ASHTON AVE STE 212
MANASSAS VA
20109-5688
US

IV. Provider business mailing address

10307 YORKTOWN CT
GREAT FALLS VA
22066-4217
US

V. Phone/Fax

Practice location:
  • Phone: 703-369-5441
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401415604
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: