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General NPI Number Information
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NPI Number | 1770019341
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Entity Type | Organization
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Legal Business Name | LS ORTHODONTICS PLLC
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Dates
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Enumeration Date | 05/02/2017
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Last Update Date | 05/02/2017
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Provider Practice Location Address
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Address Line | 1330 NEW HAMPSHIRE AVE NW NW STE # B3
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City | WASHINGTON
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State | DC
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Zip | 20036-6350
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Country | US
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Telephone | 202-290-3934
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Fax |
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Provider Business Mailing Address
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Address Line | 1330 NEW HAMPSHIRE AVE NW NW STE # B3
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City | WASHINGTON
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State | DC
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Zip | 20036-6350
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Country | US
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Telephone | 202-290-3934
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAELAYE B SHIMELES
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Credential | D.D.S.
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Telephone | 202-290-3934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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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 | DEN1001403
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License Number State | DC
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