Healthcare Provider Details

I. General information

NPI: 1053684654
Provider Name (Legal Business Name): HOWARD UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W ST NW SUITE 454
WASHINGTON DC
20059-1022
US

IV. Provider business mailing address

PO BOX 630321 HUCOD FACULTY PRACTICE PLAN
BALTIMORE MD
21265-8321
US

V. Phone/Fax

Practice location:
  • Phone: 202-806-0367
  • Fax: 202-806-0354
Mailing address:
  • Phone: 202-806-0367
  • Fax: 202-806-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number3906
License Number StateDC

VIII. Authorized Official

Name: DR. CANDACE E MITCHELL
Title or Position: CLINIC DIRECTOR
Credential: D.D.S.
Phone: 202-806-0367