Healthcare Provider Details

I. General information

NPI: 1841405149
Provider Name (Legal Business Name): RAJDEEP S BAWA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BOBBY BAWA DDS

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8567 SUDLEY RD STE A
MANASSAS VA
20110-3865
US

IV. Provider business mailing address

8567 SUDLEY RD STE A
MANASSAS VA
20110-3865
US

V. Phone/Fax

Practice location:
  • Phone: 703-369-4545
  • Fax: 703-368-6999
Mailing address:
  • Phone: 703-369-4545
  • Fax: 703-368-6999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12401
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: