=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093181901
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COSMO SMILES DENTAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2015
-----------------------------------------------------
Last Update Date | 08/14/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6214 OLD FRANCONIA RD SUITE # A
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22310-3400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 857-234-9132
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6214 OLD FRANCONIA RD SUITE # A
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22310-3400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 857-234-9132
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. AJINDER KAUR
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 857-234-9132
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 0401414540
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------