Provider Demographics
NPI:1962189704
Name:BHARUCHA, NATASHA (DDS)
Entity type:Individual
Prefix:DR
First Name:NATASHA
Middle Name:
Last Name:BHARUCHA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4652 HALLOWED STRM
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-6002
Mailing Address - Country:US
Mailing Address - Phone:301-641-0525
Mailing Address - Fax:
Practice Address - Street 1:13350 FRANKLIN FARM RD
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-4091
Practice Address - Country:US
Practice Address - Phone:301-641-0525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA041014183511223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty