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General NPI Number Information
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NPI Number | 1477981926
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Entity Type | Organization
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Legal Business Name | DIMPLES DENTAL SUITE, PC
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Dates
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Enumeration Date | 10/20/2013
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Last Update Date | 11/25/2016
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Provider Practice Location Address
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Address Line | 2811 PENNSYLVANIA AVE SE SUITE 2
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City | WASHINGTON
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State | DC
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Zip | 20020-3865
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Country | US
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Telephone | 202-584-0710
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Fax | 202-575-3627
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Provider Business Mailing Address
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Address Line | 2811 PENNSYLVANIA AVE SE SUITE 2
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City | WASHINGTON
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State | DC
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Zip | 20020-3865
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Country | US
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Telephone | 202-584-0710
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Fax | 202-575-3627
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TAKEISHA ROCHELLE PRESSON
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Credential | D.D.S.
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Telephone | 202-297-4592
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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 | DEN1000789
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License Number State | DC
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