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General NPI Number Information
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NPI Number | 1497291934
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Entity Type | Organization
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Legal Business Name | NKUTUKIRUNDA,DDS,PLLC
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Dates
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Enumeration Date | 01/08/2017
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Last Update Date | 01/08/2017
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Provider Practice Location Address
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Address Line | 1145 19TH ST NW SUITE 714
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City | WASHINGTON
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State | DC
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Zip | 20036-3701
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Country | US
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Telephone | 202-775-1414
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Fax |
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Provider Business Mailing Address
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Address Line | 1506 MARTIN LUTHER KING DR
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City | BLOOMINGTON
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State | IL
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Zip | 61701-1460
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Country | US
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Telephone | 301-273-8549
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MOHAMMED NKUTU KIRUNDA
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Credential | DDS
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Telephone | 301-273-8549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN1001679
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License Number State | DC
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