| NPI | 1902809585 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA D. JACKSON Associate Dean For Clinical Affairs 202-806-0064 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: DC DEN4077) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2022-07-22 |