Provider Demographics
NPI:1619469533
Name:KATYAL, VIDUR JORDAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:VIDUR
Middle Name:JORDAN
Last Name:KATYAL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8314 TRAFORD LN STE A
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1661
Mailing Address - Country:US
Mailing Address - Phone:703-451-0502
Mailing Address - Fax:
Practice Address - Street 1:8314 TRAFORD LN STE A
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1661
Practice Address - Country:US
Practice Address - Phone:703-451-0502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014159511223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics