Provider Demographics
NPI:1275806226
Name:SBK DDS PC
Entity Type:Organization
Organization Name:SBK DDS PC
Other - Org Name:ELEGANT SMILES DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KUMRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-750-1099
Mailing Address - Street 1:4810 BEAUREGARD ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-1709
Mailing Address - Country:US
Mailing Address - Phone:703-750-1099
Mailing Address - Fax:
Practice Address - Street 1:4810 BEAUREGARD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-1709
Practice Address - Country:US
Practice Address - Phone:703-750-1099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014114291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty