Healthcare Provider Details

I. General information

NPI: 1871314302
Provider Name (Legal Business Name): EPP WASHINGTON DC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 K ST NW STE 305
WASHINGTON DC
20006-1003
US

IV. Provider business mailing address

PO BOX 1584
BRENTWOOD TN
37024-1584
US

V. Phone/Fax

Practice location:
  • Phone: 202-835-3636
  • Fax:
Mailing address:
  • Phone: 315-450-0763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: JASON BERTOLLINI
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 315-450-0763