| NPI | 1962663203 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAMEASA LAVONNE JOHNSON Office Contact 301-870-7077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MD 10857) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2008-06-19 |