Healthcare Provider Details

I. General information

NPI: 1679890834
Provider Name (Legal Business Name): GEORGETOWN ORAND & MAX SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 JENIFER ST NW SUITE 270
WASHINGTON DC
20015-2113
US

IV. Provider business mailing address

4400 JENIFER ST NW SUITE 270
WASHINGTON DC
20015-2113
US

V. Phone/Fax

Practice location:
  • Phone: 202-364-9400
  • Fax: 202-364-1511
Mailing address:
  • Phone: 202-364-9400
  • Fax: 202-364-1511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAWN MARIE UYEUNTEN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 202-364-9400