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General NPI Number Information
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NPI Number | 1134614092
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Entity Type | Organization
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Legal Business Name | SPECIALIST CARE ENDODONTICS LLC
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Dates
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Enumeration Date | 06/24/2018
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Last Update Date | 06/24/2018
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Provider Practice Location Address
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Address Line | 1964 GALLOWS RD STE 220
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City | VIENNA
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State | VA
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Zip | 22182-3814
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Country | US
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Telephone | 703-650-9990
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Fax | 703-650-9991
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Provider Business Mailing Address
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Address Line | 1964 GALLOWS RD STE 220
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City | VIENNA
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State | VA
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Zip | 22182-3814
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Country | US
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Telephone | 703-650-9990
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Fax | 703-650-9991
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. ARUNDHATI MISRA SAUPARN
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Credential | BDS, ENDODONTIST
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Telephone | 646-492-0226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 0401415163
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License Number State | VA
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