Provider Demographics
NPI:1457512188
Name:DEEPAK KAKAR DDS
Entity Type:Organization
Organization Name:DEEPAK KAKAR DDS
Other - Org Name:FREDERICKSBURG PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:SPEAR-VENTRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-786-0051
Mailing Address - Street 1:927 MAPLE GROVE DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-6936
Mailing Address - Country:US
Mailing Address - Phone:540-786-0051
Mailing Address - Fax:540-786-0999
Practice Address - Street 1:927 MAPLE GROVE DR
Practice Address - Street 2:SUITE 111
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6936
Practice Address - Country:US
Practice Address - Phone:540-786-0051
Practice Address - Fax:540-786-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014105731223P0221X
VA04014109721223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1710081195OtherNPI NUMBER DR. BYRD
VA1174626717OtherPROVIDER NPI NUMBER
VA1477606465OtherNPI NUMBER DR. LUNA