Provider Demographics
NPI:1417719725
Name:2843 DENTAL LLC
Entity Type:Organization
Organization Name:2843 DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GIRISH
Authorized Official - Middle Name:
Authorized Official - Last Name:BANAJI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-849-1300
Mailing Address - Street 1:2843 HARTLAND RD STE 250
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-3543
Mailing Address - Country:US
Mailing Address - Phone:703-849-1300
Mailing Address - Fax:
Practice Address - Street 1:2843 HARTLAND RD STE 250
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-3543
Practice Address - Country:US
Practice Address - Phone:703-849-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty