MEDICARE: SAMEER KWATRA DDS, PC

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	1223G0001X	General Practice Dentistry	0401410643	VA

General Provider Information

NPI Number	:	1861683666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMEER KWATRA DDS, PC

Provider Business Mailing Address
First Line	:	2970 PRINCE WILLIAM PKWY
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-4145
Country	:	US
Telephone Number	:	703-583-7720
Fax Number	:	703-583-7719

Provider Business Practice Location Address
First Line	:	2970 PRINCE WILLIAM PKWY
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-4145
Country	:	US
Telephone Number	:	703-583-7720
Fax Number	:	703-583-7719

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. SAMEER KWATRA
Credential	:	D.D.S.
Telephone Number	:	703-583-7720

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	08/06/2007

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