Provider Demographics
NPI:1598432791
Name:BAWA, DEVAANSH (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:DEVAANSH
Middle Name:
Last Name:BAWA
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13100 LOU ALICE WAY
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-4206
Mailing Address - Country:US
Mailing Address - Phone:571-218-0083
Mailing Address - Fax:
Practice Address - Street 1:5401B LANGSTON BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-1632
Practice Address - Country:US
Practice Address - Phone:703-536-7846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014186961223X0400X
MD181251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics