MEDICARE: PAWNEET KAUR KHANGURA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		NY
2	1223G0001X	General Practice Dentistry	0401417846	VA
3	1223G0001X	General Practice Dentistry	DEN1002168	DC

General Provider Information

NPI Number	:	1467060061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAWNEET KAUR KHANGURA DDS

Provider Business Mailing Address
First Line	:	1899 ORACLE WAY
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20190-6707
Country	:	US
Telephone Number	:	347-417-4141
Fax Number	:

Provider Business Practice Location Address
First Line	:	6303 LITTLE RIVER TPKE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22312-5000
Country	:	US
Telephone Number	:	571-603-7388
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2020
Last Update Date	:	03/16/2026

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