| NPI | 1720297344 |
|---|---|
| Other Name | CONNECTICUT AVENUE DENTAL |
| Entity Type | Organization |
| Authorized Contact | ST.ELMO WALLACE CRAWFORD President 202-399-2244 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: DC DEN3272) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: DC DEN3272) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: DC DEN3272) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2012-12-13 |