Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 0401410262 | VA |
NPI | 1366510125 |
---|---|
Provider Name | Dr. Gayatri Manoj Chaubal |
First Address | Oak Hill, VA 20171 |
Second Address | Reston, VA 20190 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 08/07/2007 |