Provider Demographics
NPI:1801020201
Name:SASAN, KAWAL R (DDS)
Entity Type:Individual
Prefix:
First Name:KAWAL
Middle Name:R
Last Name:SASAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14393 HEREFORD RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-2107
Mailing Address - Country:US
Mailing Address - Phone:703-670-8400
Mailing Address - Fax:
Practice Address - Street 1:14393 HEREFORD RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-2107
Practice Address - Country:US
Practice Address - Phone:703-670-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014117611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice