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General Practice >> Dentist >> Dental Providers

Registrant NPI Number: 1508829458

Individual Registrant:
Gender: M

Location and contact information for practice:
110 LUKE AVE SW ROOM 380 BOLLING AFB, DC 20032-6400 US
Tel: 202-767-4403  Fax: --

Contact information for business:
8475 WEDDING DR  WELCOME, MD 20693-3601 US
Tel: 301-934-6967  Fax: --

Registration Information:
NPI: 1508829458
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
General Practice

Legacy codes, insurance codes and state license numbers:



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