Provider Demographics
NPI:1932488814
Name:GICHANA, ROSELYNE N (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROSELYNE
Middle Name:N
Last Name:GICHANA
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 1:6105 MADAWASKA RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-3110
Mailing Address - Country:US
Mailing Address - Phone:571-296-1669
Mailing Address - Fax:703-852-7072
Practice Address - Street 1:6400 ARLINGTON BLVD
Practice Address - Street 2:SUITE 80
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-2325
Practice Address - Country:US
Practice Address - Phone:703-533-5511
Practice Address - Fax:703-852-7072
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014134141223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA061431900Medicaid