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General NPI Number Information
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NPI Number | 1154114296
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Entity Type | Organization
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Legal Business Name | GDAT SHUKRANA PLLC
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Dates
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Enumeration Date | 05/22/2025
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 10563 CRESTWOOD DR
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City | MANASSAS
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State | VA
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Zip | 20109-3406
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Country | US
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Telephone | 703-899-8523
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Fax |
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Provider Business Mailing Address
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Address Line | 7658 CLIFTON RD
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City | FAIRFAX STATION
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State | VA
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Zip | 22039-2030
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Country | US
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Telephone | 703-582-9611
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Fax |
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Authorized Official
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Title or Position | DDS OWNER
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Name | DR. DIVISPREET KAUR LUDHER
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Credential | DDS
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Telephone | 703-899-8523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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