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General NPI Number Information
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NPI Number | 1083214829
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Entity Type | Organization
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Legal Business Name | EVENLY DC, PLLC
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Dates
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Enumeration Date | 10/30/2020
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Last Update Date | 10/30/2020
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Provider Practice Location Address
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Address Line | 1619 CONNECTICUT AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20009-1013
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Country | US
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Telephone | 202-342-9600
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Fax | 202-591-1377
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Provider Business Mailing Address
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Address Line | 7402 FAIRFAX RD
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City | BETHESDA
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State | MD
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Zip | 20814-1241
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Country | US
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Telephone | 202-342-9600
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Fax | 202-591-1377
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Authorized Official
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Title or Position | CFO
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Name | BERNARD LOCRAFT
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Credential |
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Telephone | 202-805-5865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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