Provider Demographics
NPI:1215189493
Name:BAJWA, PREET (DDS)
Entity Type:Individual
Prefix:DR
First Name:PREET
Middle Name:
Last Name:BAJWA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20048 BOXWOOD PL
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5641
Mailing Address - Country:US
Mailing Address - Phone:202-903-4815
Mailing Address - Fax:
Practice Address - Street 1:20048 BOXWOOD PL
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5641
Practice Address - Country:US
Practice Address - Phone:202-903-4815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-19
Last Update Date:2008-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412299122300000X
NY053043122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist