Provider Demographics
NPI:1689389314
Name:KALAMBAYI T KABASELA DDS PC
Entity Type:Organization
Organization Name:KALAMBAYI T KABASELA DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KALAMBAYI
Authorized Official - Middle Name:T
Authorized Official - Last Name:KABASELA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-585-0405
Mailing Address - Street 1:8380 COLESVILLE ROAD
Mailing Address - Street 2:SUITE 750
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910
Mailing Address - Country:US
Mailing Address - Phone:301-585-0405
Mailing Address - Fax:301-585-0512
Practice Address - Street 1:8380 COLESVILLE ROAD
Practice Address - Street 2:SUITE 750
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910
Practice Address - Country:US
Practice Address - Phone:301-585-0405
Practice Address - Fax:301-585-0512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD811023900Medicaid