=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235545955
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INGBER DENTAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2014
-----------------------------------------------------
Last Update Date | 07/02/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2021 K ST NW STE 702
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20006-1003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-331-7474
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5614 OAKMONT AVE
-----------------------------------------------------
City | BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20817-3530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-551-9604
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ASSOCIATE DENTIST
-----------------------------------------------------
Name | JULIE BHARUCHA
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 845-551-9604
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DEN1001392
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------