Healthcare Provider Details

I. General information

NPI: 1386917755
Provider Name (Legal Business Name): FORT DAVIS DENTAL ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 02/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 GOOD HOPE RD SE SUITE 3
WASHINGTON DC
20020-5147
US

IV. Provider business mailing address

2300 GOOD HOPE RD SE SUITE 3
WASHINGTON DC
20020-5147
US

V. Phone/Fax

Practice location:
  • Phone: 202-889-8200
  • Fax: 202-889-5891
Mailing address:
  • Phone: 202-889-8200
  • Fax: 202-889-5891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDEN3045
License Number StateDC

VIII. Authorized Official

Name: DR. ISAIAH PURNELL MORRISON III
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 202-889-8200