Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 0401411238 | VA |
NPI | 1083814578 |
---|---|
Provider Name | Dr. Rishita A Jaju |
First Address | Reston, VA 20191-1440 |
Second Address | Reston, VA 20191-1440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2007 |
Last Update Date | 19/09/2015 |