Healthcare Provider Details

I. General information

NPI: 1932273489
Provider Name (Legal Business Name): DOUGLAS DOMPKOWSKI D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5411 W CEDAR LN SUITE# 206-A
BETHESDA MD
20814-1516
US

IV. Provider business mailing address

5411 W CEDAR LN SUITE# 206-A
BETHESDA MD
20814-1516
US

V. Phone/Fax

Practice location:
  • Phone: 301-530-5858
  • Fax:
Mailing address:
  • Phone: 301-530-5858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number11791
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: