Healthcare Provider Details

I. General information

NPI: 1417792888
Provider Name (Legal Business Name): KRITISHA KUNWAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8056 ROLLING RD
SPRINGFIELD VA
22153-2928
US

IV. Provider business mailing address

12231 APPLE ORCHARD CT
FAIRFAX VA
22033-2818
US

V. Phone/Fax

Practice location:
  • Phone: 571-295-5683
  • Fax:
Mailing address:
  • Phone: 571-330-1272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401420096
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: