Provider Demographics
NPI:1003240276
Name:ASHTAKALA, CHARANPREET (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARANPREET
Middle Name:
Last Name:ASHTAKALA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 N HENDERSON RD STE 14
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-2452
Mailing Address - Country:US
Mailing Address - Phone:703-249-5069
Mailing Address - Fax:
Practice Address - Street 1:4141 N HENDERSON RD STE 15
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-2452
Practice Address - Country:US
Practice Address - Phone:703-249-5069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414759122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist