Provider Demographics
NPI:1861938789
Name:SPA DENTAL GROUP INC.
Entity type:Organization
Organization Name:SPA DENTAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEBANI
Authorized Official - Middle Name:
Authorized Official - Last Name:PAHWA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-910-3100
Mailing Address - Street 1:721 5TH AVE APT 37F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2537
Mailing Address - Country:US
Mailing Address - Phone:202-431-6957
Mailing Address - Fax:
Practice Address - Street 1:1201 I ST NW STE 110A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-6004
Practice Address - Country:US
Practice Address - Phone:202-431-6957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1001562122300000X
261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No122300000XDental ProvidersDentistGroup - Single Specialty