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General NPI Number Information
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NPI Number | 1003067778
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Entity Type | Individual
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Provider Name | TOMELL LEMART DUBOSE
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Gender | Male
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Dates
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Enumeration Date | 09/30/2008
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Last Update Date | 09/30/2008
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Provider Practice Location Address
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Address Line | 5437 CONNECTICUT AVE NW 203
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City | WASHINGTON
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State | DC
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Zip | 20015-2770
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Country | US
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Telephone | 202-364-6550
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Fax | 202-364-7297
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Provider Business Mailing Address
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Address Line | 5437 CONNECTICUT AVE NW 203
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City | WASHINGTON
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State | DC
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Zip | 20015-2770
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Country | US
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Telephone | 202-364-6550
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Fax | 202-364-7297
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5980
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License Number State | DC
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