Healthcare Provider Details

I. General information

NPI: 1881520195
Provider Name (Legal Business Name): LA LUXE DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 1ST ST NE STE 101
WASHINGTON DC
20002-7591
US

IV. Provider business mailing address

1050 1ST ST NE STE 101
WASHINGTON DC
20002-7591
US

V. Phone/Fax

Practice location:
  • Phone: 202-918-1204
  • Fax: 202-918-1205
Mailing address:
  • Phone: 202-918-1204
  • Fax: 202-918-1205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ASHLEY FAGAN
Title or Position: CEO/DENTIST
Credential: DDS
Phone: 202-918-1201