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General NPI Number Information
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NPI Number | 1154062990
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Entity Type | Individual
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Provider Name | MICHAEL CEVALLOS DMD
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Gender | Male
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 09/04/2023
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Provider Practice Location Address
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Address Line | 100 GALLATIN STREET NE
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City | WASHINGTON
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State | DC
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Zip | 20011-2027
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Country | US
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Telephone | 202-483-8196
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Fax |
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Provider Business Mailing Address
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Address Line | 11919 RIMSWELL MEWS
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City | MIDLOTHIAN
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State | VA
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Zip | 23112
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Country | US
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Telephone | 804-433-5921
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN2000289
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License Number State | DC
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