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General NPI Number Information
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NPI Number | 1528101805
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Entity Type | Individual
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Provider Name | KAMRAN NAWAZ RAJA DMD, MD, FACS
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Gender | Male
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 11/12/2019
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Provider Practice Location Address
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Address Line | 24805 PINEBROOK RD STE 318
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City | CHANTILLY
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State | VA
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Zip | 20152
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Country | US
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Telephone | 703-653-0989
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Fax | 703-653-0989
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Provider Business Mailing Address
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Address Line | 9209 MAROVELLI FOREST DR
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City | LORTON
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State | VA
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Zip | 22079-3456
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Country | US
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Telephone | 571-218-0878
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 13740
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 0401416412
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License Number State | VA
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