| NPI | 1710302690 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOUIS BWANA KALOMBO Dentist 301-505-2550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEN1001312) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414224) |
| 122300000X Dentist (Licence: MD 15372) | |
| Enumeration Date | 2014-02-28 |
| Last Update Date | 2014-03-04 |