Provider Demographics
NPI:1134614092
Name:SPECIALIST CARE ENDODONTICS LLC
Entity type:Organization
Organization Name:SPECIALIST CARE ENDODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARUNDHATI
Authorized Official - Middle Name:MISRA
Authorized Official - Last Name:SAUPARN
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, ENDODONTIST
Authorized Official - Phone:646-492-0226
Mailing Address - Street 1:1964 GALLOWS RD STE 220
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3814
Mailing Address - Country:US
Mailing Address - Phone:703-650-9990
Mailing Address - Fax:703-650-9991
Practice Address - Street 1:1964 GALLOWS RD STE 220
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3814
Practice Address - Country:US
Practice Address - Phone:703-650-9990
Practice Address - Fax:703-650-9991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-24
Last Update Date:2018-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014151631223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty