Healthcare Provider Details

I. General information

NPI: 1386246494
Provider Name (Legal Business Name): MS. DOMINIQUE ANN WASHINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 11/13/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 OAK ST
CINCINNATI OH
45219-2504
US

IV. Provider business mailing address

411 OAK ST
CINCINNATI OH
45219-2504
US

V. Phone/Fax

Practice location:
  • Phone: 513-984-1800
  • Fax: 513-984-4909
Mailing address:
  • Phone: 513-984-1800
  • Fax: 513-984-4909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: