Healthcare Provider Details

I. General information

NPI: 1699258533
Provider Name (Legal Business Name): LAVERNE THOMAS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 SILVER HILL RD
SUITLAND MD
20746-2700
US

IV. Provider business mailing address

7701 DON DR
CLINTON MD
20735-1919
US

V. Phone/Fax

Practice location:
  • Phone: 301-899-2500
  • Fax:
Mailing address:
  • Phone: 202-412-2045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberHYG1000685
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: