Healthcare Provider Details

I. General information

NPI: 1770019341
Provider Name (Legal Business Name): LS ORTHODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 NEW HAMPSHIRE AVE NW NW STE # B3
WASHINGTON DC
20036-6350
US

IV. Provider business mailing address

1330 NEW HAMPSHIRE AVE NW NW STE # B3
WASHINGTON DC
20036-6350
US

V. Phone/Fax

Practice location:
  • Phone: 202-290-3934
  • Fax:
Mailing address:
  • Phone: 202-290-3934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN1001403
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. LAELAYE B SHIMELES
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 202-290-3934