Healthcare Provider Details

I. General information

NPI: 1841754710
Provider Name (Legal Business Name): JOBENA RENAE TABRON HELLAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 13TH ST NW
WASHINGTON DC
20011-4410
US

IV. Provider business mailing address

4820 13TH ST NW
WASHINGTON DC
20011-4410
US

V. Phone/Fax

Practice location:
  • Phone: 202-829-3100
  • Fax:
Mailing address:
  • Phone: 202-829-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberHYG1000718
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: