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General NPI Number Information
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NPI Number | 1366733461
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Entity Type | Individual
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Provider Name | JUSTIN HENRY DECKARD D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/22/2011
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Last Update Date | 05/15/2016
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Provider Practice Location Address
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Address Line | 1712 EYE ST NW SUITE 710
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City | WASHINGTON
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State | DC
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Zip | 20006-3702
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Country | US
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Telephone | 202-659-1227
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Fax | 202-833-2632
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Provider Business Mailing Address
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Address Line | 1712 EYE ST NW SUITE 710
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City | WASHINGTON
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State | DC
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Zip | 20006-3702
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Country | US
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Telephone | 202-659-1227
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Fax | 202-833-2632
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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 | 15175
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN1001339
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License Number State | DC
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