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General NPI Number Information
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NPI Number | 1801870928
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Entity Type | Individual
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Provider Name | CHAD ALAN KASPEROWSKI D.M.D
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Gender | Male
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Dates
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Enumeration Date | 12/01/2005
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Last Update Date | 07/23/2019
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Provider Practice Location Address
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Address Line | 11198 LEE HIGHWAY
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City | FAIRFAX
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State | VA
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Zip | 22030
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Country | US
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Telephone | 703-591-5637
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Fax | 703-591-7934
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Provider Business Mailing Address
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Address Line | 8270 WILLOW OAKS CORPORATE DR STE 650
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City | FAIRFAX
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State | VA
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Zip | 22031-4511
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Country | US
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Telephone | 703-591-5637
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Fax | 703-591-7934
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 411416
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 20754
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401411416
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License Number State | VA
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