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General NPI Number Information
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NPI Number | 1063621886
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Entity Type | Organization
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Legal Business Name | BAWA PLLC
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 12/27/2010
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Provider Practice Location Address
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Address Line | 8567 SUDLEY RD STE A
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City | MANASSAS
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State | VA
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Zip | 20110-3865
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Country | US
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Telephone | 571-344-3397
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Fax |
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Provider Business Mailing Address
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Address Line | 8567 SUDLEY RD STE A
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City | MANASSAS
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State | VA
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Zip | 20110-3865
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Country | US
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Telephone | 571-344-3397
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ANOOP S BAWA
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Credential | DMD
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Telephone | 571-344-3397
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401412382
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401412401
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 46686
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 50846
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License Number State | CA
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