Healthcare Provider Details

I. General information

NPI: 1346829322
Provider Name (Legal Business Name): KAPIL KOTADIA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8056 ROLLING RD
SPRINGFIELD VA
22153-2928
US

IV. Provider business mailing address

43302 HEATHER LEIGH CT
ASHBURN VA
20147-3157
US

V. Phone/Fax

Practice location:
  • Phone: 571-295-5683
  • Fax:
Mailing address:
  • Phone: 703-727-8293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401417880
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: