Provider Demographics
NPI:1164620142
Name:DULABH, MITA (DMD)
Entity Type:Individual
Prefix:
First Name:MITA
Middle Name:
Last Name:DULABH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5587 CALLCOTT WAY
Mailing Address - Street 2:APT 1102
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-4009
Mailing Address - Country:US
Mailing Address - Phone:859-576-5459
Mailing Address - Fax:
Practice Address - Street 1:2970 PRINCE WILLIAM PKWY
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4145
Practice Address - Country:US
Practice Address - Phone:703-583-7720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412184122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist