=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376420505
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR NILI DENTAL CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2025
-----------------------------------------------------
Last Update Date | 08/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1635 N GEORGE MASON DR STE 160
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22205-3680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-522-3363
-----------------------------------------------------
Fax | 703-522-3370
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1635 N GEORGE MASON DR STE 160
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22205-3680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-522-3363
-----------------------------------------------------
Fax | 703-522-3370
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ DENTIST
-----------------------------------------------------
Name | NILIMA RUNWAL
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 703-522-3363
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------