=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417511627
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TUSK ORTHODONTICS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2019
-----------------------------------------------------
Last Update Date | 04/24/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3900 KANSAS AVE NW STE 101
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20011-5712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-505-5373
-----------------------------------------------------
Fax | 866-713-2362
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3830 10TH ST NW
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20011-5708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-236-4339
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ORTHODONTIST
-----------------------------------------------------
Name | DR. RAVI KUMAR SAWHNEY
-----------------------------------------------------
Credential | DDS, MSD, PHD
-----------------------------------------------------
Telephone | 202-236-4339
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------