Provider Demographics
NPI:1801870928
Name:KASPEROWSKI, CHAD ALAN (DMD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:ALAN
Last Name:KASPEROWSKI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8270 WILLOW OAKS CORPORATE DR STE 650
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4511
Mailing Address - Country:US
Mailing Address - Phone:703-591-5637
Mailing Address - Fax:703-591-7934
Practice Address - Street 1:11198 LEE HIGHWAY
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-591-5637
Practice Address - Fax:703-591-7934
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA411416122300000X
MA207541223G0001X
VA04014114161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist