Healthcare Provider Details

I. General information

NPI: 1609154855
Provider Name (Legal Business Name): JUDITH THEOMAT EUGENE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 GALEN ST SE
WASHINGTON DC
20020-4936
US

IV. Provider business mailing address

2250 CHAMPLAIN STREET SW
WASHINGTON DC
20009-2618
US

V. Phone/Fax

Practice location:
  • Phone: 202-610-7160
  • Fax: 202-610-7164
Mailing address:
  • Phone: 202-232-9022
  • Fax: 202-232-8494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN1001135
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: