Provider Demographics
NPI:1861683666
Name:SAMEER KWATRA DDS, PC
Entity Type:Organization
Organization Name:SAMEER KWATRA DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMEER
Authorized Official - Middle Name:
Authorized Official - Last Name:KWATRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-583-7720
Mailing Address - Street 1:2970 PRINCE WILLIAM PKWY
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4145
Mailing Address - Country:US
Mailing Address - Phone:703-583-7720
Mailing Address - Fax:703-583-7719
Practice Address - Street 1:2970 PRINCE WILLIAM PKWY
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4145
Practice Address - Country:US
Practice Address - Phone:703-583-7720
Practice Address - Fax:703-583-7719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014106431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty