Provider Demographics
NPI:1710004304
Name:KABASELA, KALAMABYI T (DDS)
Entity Type:Individual
Prefix:DR
First Name:KALAMABYI
Middle Name:T
Last Name:KABASELA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8380 COLESVILLE RD
Mailing Address - Street 2:SUITE 750
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-6255
Mailing Address - Country:US
Mailing Address - Phone:301-585-0405
Mailing Address - Fax:301-585-0512
Practice Address - Street 1:8380 COLESVILLE RD
Practice Address - Street 2:SUITE 750
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-6255
Practice Address - Country:US
Practice Address - Phone:301-585-0405
Practice Address - Fax:301-585-0512
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD85501223P0700X
DC43031223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics