Provider Demographics
NPI:1649833724
Name:CHAUDHRY, JAWAD RASOOL (DDS)
Entity type:Individual
Prefix:
First Name:JAWAD
Middle Name:RASOOL
Last Name:CHAUDHRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6717 SWINDON PL
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-5569
Mailing Address - Country:US
Mailing Address - Phone:703-608-0721
Mailing Address - Fax:
Practice Address - Street 1:112 FALCON DR # 1931
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-1931
Practice Address - Country:US
Practice Address - Phone:540-898-8805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014165801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice