Provider Demographics
NPI:1003561648
Name:KULBIR S GORAYA DDS PC
Entity Type:Organization
Organization Name:KULBIR S GORAYA DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KULBIR
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:GORAYA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-286-1110
Mailing Address - Street 1:4332 STILL MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-1633
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:560 CELEBRATE VIRGINIA PKWY STE 107
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-7298
Practice Address - Country:US
Practice Address - Phone:540-286-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-12
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental