Provider Demographics
NPI:1104652775
Name:DJ PRACTICES PLLC
Entity type:Organization
Organization Name:DJ PRACTICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HETA
Authorized Official - Middle Name:S
Authorized Official - Last Name:JASANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-744-7031
Mailing Address - Street 1:19415 DEERFIELD AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8471
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19415 DEERFIELD AVE STE 212
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-8471
Practice Address - Country:US
Practice Address - Phone:301-744-7031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty