Provider Demographics
NPI:1679969042
Name:MARWAHA, ANGELA (DMD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MARWAHA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6035 BURKE CENTRE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3750
Mailing Address - Country:US
Mailing Address - Phone:703-750-9404
Mailing Address - Fax:
Practice Address - Street 1:6035 BURKE CENTRE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-3750
Practice Address - Country:US
Practice Address - Phone:703-750-9404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-12
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD165971223G0001X
VA04014154011223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program