Provider Demographics
NPI:1366721805
Name:JASANI, KRINA (DMD)
Entity type:Individual
Prefix:
First Name:KRINA
Middle Name:
Last Name:JASANI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 DUKE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4522
Mailing Address - Country:US
Mailing Address - Phone:703-705-9779
Mailing Address - Fax:
Practice Address - Street 1:3303 DUKE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4522
Practice Address - Country:US
Practice Address - Phone:202-999-6639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD152231223G0001X
VA04014134621223G0001X
NJDI024765001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice