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General NPI Number Information
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NPI Number | 1033402136
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Entity Type | Organization
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Legal Business Name | SAINT ELIZABETHS HOSPITAL DENTAL CLINIC
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Dates
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Enumeration Date | 05/23/2011
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Last Update Date | 05/23/2011
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Provider Practice Location Address
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Address Line | 1100 ALABAMA AVE SE
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City | WASHINGTON
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State | DC
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Zip | 20032-4540
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Country | US
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Telephone | 202-299-5610
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 ALABAMA AVE SE
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City | WASHINGTON
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State | DC
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Zip | 20032-4540
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Country | US
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Telephone | 202-299-5610
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. PATRICK J CANAVAN
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Credential | PSY.D
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Telephone | 202-299-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | HFD01-0230
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License Number State | DC
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