Healthcare Provider Details

I. General information

NPI: 1376293555
Provider Name (Legal Business Name): PAMELA MARIE WASHINGTON DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 BRECKINRIDGE BLVD STE 200
DULUTH GA
30096-4959
US

IV. Provider business mailing address

3117 PITTARD HILL PT
DULUTH GA
30096-2222
US

V. Phone/Fax

Practice location:
  • Phone: 770-962-8396
  • Fax:
Mailing address:
  • Phone: 504-452-3733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN122758
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: