=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811333685
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAY DENTAL CARE ASSOCIATES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2013
-----------------------------------------------------
Last Update Date | 05/20/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8393 CENTREVILLE RD
-----------------------------------------------------
City | MANASSAS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-686-4343
-----------------------------------------------------
Fax | 703-686-4344
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8393 CENTREVILLE RD
-----------------------------------------------------
City | MANASSAS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-686-4343
-----------------------------------------------------
Fax | 703-686-4344
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR/PRESIDENT
-----------------------------------------------------
Name | JATINDER KALER
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 703-686-4343
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 0401413552
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------