Healthcare Provider Details

I. General information

NPI: 1962339341
Provider Name (Legal Business Name): DC PERIO& IMPLANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 I ST NW STE 202
WASHINGTON DC
20006-3744
US

IV. Provider business mailing address

1712 I ST NW STE 202
WASHINGTON DC
20006-3744
US

V. Phone/Fax

Practice location:
  • Phone: 202-659-3500
  • Fax:
Mailing address:
  • Phone: 202-659-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: MARIA TARRANCE-WATKINS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 202-659-3500