Healthcare Provider Details

I. General information

NPI: 1902809585
Provider Name (Legal Business Name): HOWARD UNIVERSITY COLLEGE OF DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W ST. NW SUITE 326
WASHINGTON DC
20059-0001
US

IV. Provider business mailing address

600 W ST. NW SUITE 326
WASHINGTON DC
20059-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-806-0066
  • Fax: 202-806-0354
Mailing address:
  • Phone: 202-806-0066
  • Fax: 202-806-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDEN4077
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MS. ANDREA D. JACKSON
Title or Position: ASSOCIATE DEAN FOR CLINICAL AFFAIRS
Credential: DDS, MS
Phone: 202-806-0064