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General NPI Number Information
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NPI Number | 1598873317
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Entity Type | Organization
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Legal Business Name | LAKE ARBOR DENTAL ASSOC
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 411 8TH ST SE
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City | WASHINGTON
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State | DC
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Zip | 20003
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Country | US
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Telephone | 202-547-0900
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Fax | 202-547-4085
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Provider Business Mailing Address
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Address Line | 411 8TH ST SE
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City | WASHINGTON
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State | DC
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Zip | 20003
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Country | US
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Telephone | 202-547-0900
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Fax | 202-547-4085
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | ARTHUR DOUGLAS STUBBS
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Credential | DDS
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Telephone | 202-547-0900
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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 | 03980
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License Number State | DC
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