Healthcare Provider Details

I. General information

NPI: 1770624454
Provider Name (Legal Business Name): JOHN W. ROXBOROUGH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 W ST SE
WASHINGTON DC
20020-5718
US

IV. Provider business mailing address

3020 14TH ST NW SUITE 402B
WASHINGTON DC
20009-6865
US

V. Phone/Fax

Practice location:
  • Phone: 202-610-7160
  • Fax: 202-610-7164
Mailing address:
  • Phone: 202-745-4300
  • Fax: 202-462-3428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN3496
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: