Provider Demographics
NPI:1396212254
Name:KANBARAGHA DDS PLLC
Entity Type:Organization
Organization Name:KANBARAGHA DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-714-7374
Mailing Address - Street 1:8300 BOONE BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182
Mailing Address - Country:US
Mailing Address - Phone:703-714-7374
Mailing Address - Fax:
Practice Address - Street 1:8300 BOONE BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182
Practice Address - Country:US
Practice Address - Phone:703-714-7374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty