=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962836072
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RK DENTAL CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2013
-----------------------------------------------------
Last Update Date | 08/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12011 LEE JACKSON MEMORIAL HWY SUITE 502
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22033-3310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-268-5622
-----------------------------------------------------
Fax | 703-268-5622
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12011 LEE JACKSON MEMORIAL HWY SUITE 502
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22033-3310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-268-5622
-----------------------------------------------------
Fax | 703-268-5622
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KOMAL SAAKHA KARMACHARYA
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 571-295-7757
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 0401413654
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------