Provider Demographics
NPI:1770941080
Name:KARA, OFELIYA I
Entity type:Individual
Prefix:
First Name:OFELIYA
Middle Name:
Last Name:KARA
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1664 PARKCREST CIR
Mailing Address - Street 2:#301
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-4952
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9010 LORTON STATION BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-4792
Practice Address - Country:US
Practice Address - Phone:703-337-4272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014150161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice