Healthcare Provider Details

I. General information

NPI: 1316111941
Provider Name (Legal Business Name): DAVIDSON O LAWOYIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 MASSACHUSETTES AVENUE SE CAPITOL HEALTH MANAGEMENT SERVICES LLC
WASHINGTON DC
20003-2542
US

IV. Provider business mailing address

1900 MASSACHUSETTES AVENUE SE CAPITOL HEALTH MANAGEMENT SERVICES LLC
WASHINGTON DC
20003-2542
US

V. Phone/Fax

Practice location:
  • Phone: 202-548-5100
  • Fax: 202-548-5180
Mailing address:
  • Phone: 202-548-5100
  • Fax: 202-548-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN1000380
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDEN100380
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: