Healthcare Provider Details

I. General information

NPI: 1861683666
Provider Name (Legal Business Name): SAMEER KWATRA DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 PRINCE WILLIAM PKWY
WOODBRIDGE VA
22192-4145
US

IV. Provider business mailing address

2970 PRINCE WILLIAM PKWY
WOODBRIDGE VA
22192-4145
US

V. Phone/Fax

Practice location:
  • Phone: 703-583-7720
  • Fax: 703-583-7719
Mailing address:
  • Phone: 703-583-7720
  • Fax: 703-583-7719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401410643
License Number StateVA

VIII. Authorized Official

Name: DR. SAMEER KWATRA
Title or Position: DENTIST
Credential: D.D.S.
Phone: 703-583-7720