MEDICARE: DR. GIRISH BANAJI D.D.S.

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	1223P0221X	Pediatric Dentistry	0401410311	VA

General Provider Information

NPI Number	:	1477591881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GIRISH BANAJI D.D.S.

Provider Business Mailing Address
First Line	:	2843 HARTLAND RD STE 200
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22043-3539
Country	:	US
Telephone Number	:	703-849-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2843 HARTLAND RD STE 200
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22043-3539
Country	:	US
Telephone Number	:	703-849-1300
Fax Number	:

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

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	01/23/2024

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