Healthcare Provider Details

I. General information

NPI: 1598265944
Provider Name (Legal Business Name): FAMILY ORTHODONTICS OF DC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 WISCONSIN AVE NW STE 200
WASHINGTON DC
20015
US

IV. Provider business mailing address

1350 SPRING ST NW STE 600
ATLANTA GA
30309-2870
US

V. Phone/Fax

Practice location:
  • Phone: 202-686-6100
  • Fax:
Mailing address:
  • Phone: 770-692-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: TAMONIA LEONARD
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 678-244-4844