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General NPI Number Information
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NPI Number | 1699166728
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Entity Type | Organization
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Legal Business Name | SOUTH EAST DENTAL CARE PC
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Dates
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Enumeration Date | 02/11/2015
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Last Update Date | 02/11/2015
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Provider Practice Location Address
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Address Line | 4648 LIVINGSTON RD SE
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City | WASHINGTON
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State | DC
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Zip | 20032-3136
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Country | US
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Telephone | 202-422-3757
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Fax |
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Provider Business Mailing Address
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Address Line | 4648 LIVINGSTON RD SE
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City | WASHINGTON
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State | DC
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Zip | 20032-3136
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Country | US
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Telephone | 202-422-3757
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ASHRAF CHOUDHURY
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Credential |
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Telephone | 202-422-3757
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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 |
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License Number State |
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