=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154791317
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AULAKH DENTAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2015
-----------------------------------------------------
Last Update Date | 09/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9000 FERN PARK DR SUITE A2
-----------------------------------------------------
City | BURKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22015-1602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-463-9817
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9000 FERN PARK DR SUITE A2
-----------------------------------------------------
City | BURKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22015-1602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | NAVDEEP AULAKH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-581-8867
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 0401411509
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------