Healthcare Provider Details

I. General information

NPI: 1841648292
Provider Name (Legal Business Name): DENTAL PROFESSIONAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 VARNUM ST NE #006
WASHINGTON DC
20017-2107
US

IV. Provider business mailing address

1160 VARNUM ST NE #006
WASHINGTON DC
20017-2107
US

V. Phone/Fax

Practice location:
  • Phone: 202-854-7103
  • Fax: 202-635-7145
Mailing address:
  • Phone: 202-854-7103
  • Fax: 202-635-7145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN4260
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL LAMB
Title or Position: DOCTOR/OWNER
Credential: DDS
Phone: 202-854-7103