Healthcare Provider Details

I. General information

NPI: 1669621637
Provider Name (Legal Business Name): ALBERT CORNELIUS CHEEK JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 MASSACHUSETTS AVE NW UNIT 100
WASHINGTON DC
20005-4162
US

IV. Provider business mailing address

1322 HALF ST SW UNIT 301
WASHINGTON DC
20024-4100
US

V. Phone/Fax

Practice location:
  • Phone: 202-387-6116
  • Fax: 202-488-1181
Mailing address:
  • Phone: 202-488-1661
  • Fax: 202-488-1181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12452
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN1000043
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: