Provider Demographics
NPI:1265140024
Name:KUMAR, PRIYAM (DDS)
Entity type:Individual
Prefix:
First Name:PRIYAM
Middle Name:
Last Name:KUMAR
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 1:16211 SUNSET VIEW TRL
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1087
Mailing Address - Country:US
Mailing Address - Phone:703-973-5633
Mailing Address - Fax:
Practice Address - Street 1:16211 SUNSET VIEW TRL
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-1087
Practice Address - Country:US
Practice Address - Phone:703-973-5633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN20002131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice