MEDICARE: DR. KALAMABYI T KABASELA 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	1223P0700X	Prosthodontics	8550	MD
2	1223P0700X	Prosthodontics	4303	DC

General Provider Information

NPI Number	:	1710004304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KALAMABYI T KABASELA DDS

Provider Business Mailing Address
First Line	:	8380 COLESVILLE RD
Second Line	:	SUITE 750
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-6255
Country	:	US
Telephone Number	:	301-585-0405
Fax Number	:	301-585-0512

Provider Business Practice Location Address
First Line	:	8380 COLESVILLE RD
Second Line	:	SUITE 750
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-6255
Country	:	US
Telephone Number	:	301-585-0405
Fax Number	:	301-585-0512

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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