=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881090231
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAJA, RAFIQ & ASSOCIATES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2014
-----------------------------------------------------
Last Update Date | 11/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11700 PLAZA AMERICA DR SUITE 140
-----------------------------------------------------
City | RESTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20190-4751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-222-4900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11700 PLAZA AMERICA DR SUITE 140
-----------------------------------------------------
City | RESTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20190-4751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. TAIMOUR RAJA
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 434-249-3793
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 0401411994
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------