Provider Demographics
NPI:1528101805
Name:RAJA, KAMRAN NAWAZ (DMD, MD, FACS)
Entity type:Individual
Prefix:DR
First Name:KAMRAN
Middle Name:NAWAZ
Last Name:RAJA
Suffix:
Gender:M
Credentials:DMD, MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:9209 MAROVELLI FOREST DR
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-3456
Mailing Address - Country:US
Mailing Address - Phone:571-218-0878
Mailing Address - Fax:
Practice Address - Street 1:24805 PINEBROOK RD STE 318
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152
Practice Address - Country:US
Practice Address - Phone:703-653-0989
Practice Address - Fax:703-653-0989
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD137401223S0112X
VA04014164121223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery