Provider Demographics
NPI:1154114296
Name:GDAT SHUKRANA PLLC
Entity type:Organization
Organization Name:GDAT SHUKRANA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIVISPREET
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:LUDHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-899-8523
Mailing Address - Street 1:7658 CLIFTON RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-2030
Mailing Address - Country:US
Mailing Address - Phone:703-582-9611
Mailing Address - Fax:
Practice Address - Street 1:10563 CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-3406
Practice Address - Country:US
Practice Address - Phone:703-899-8523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental