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Oral Surgery, Dental Specialists

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Washington, District Of Columbia

Provider NPI: 1275536278

Provider Information:
Gender: M

Practice Location:
Tel: 202-966-3132  Fax: 202-966-0470

Business Mailing Address:
Tel: 202-966-4543  Fax: --

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y1223E0200XDental Providers

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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