Healthcare Provider Details

I. General information

NPI: 1811280472
Provider Name (Legal Business Name): SOME, INC (SO OTHERS MIGHT EAT)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 O ST NW
WASHINGTON DC
20001
US

IV. Provider business mailing address

60 O ST NW
WASHINGTON DC
20001-1259
US

V. Phone/Fax

Practice location:
  • Phone: 202-797-8806
  • Fax: 202-265-0927
Mailing address:
  • Phone: 202-797-8806
  • Fax: 202-265-0927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN1000602
License Number StateDC

VIII. Authorized Official

Name: RALPH BOYD JR.
Title or Position: PRESIDENT/CEO
Credential:
Phone: 202-797-8806