Provider Demographics
NPI:1225445182
Name:GURJAR, KAVISH
Entity type:Individual
Prefix:
First Name:KAVISH
Middle Name:
Last Name:GURJAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 PLEASANT DR STE 160
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-5831
Mailing Address - Country:US
Mailing Address - Phone:240-683-8111
Mailing Address - Fax:
Practice Address - Street 1:801 PLEASANT DR STE 160
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-5831
Practice Address - Country:US
Practice Address - Phone:240-683-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0401051223G0001X
MD162241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice