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General NPI Number Information
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NPI Number | 1902809585
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Entity Type | Organization
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Legal Business Name | HOWARD UNIVERSITY COLLEGE OF DENTISTRY
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 07/22/2022
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Provider Practice Location Address
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Address Line | 600 W ST. NW SUITE 326
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City | WASHINGTON
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State | DC
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Zip | 20059-0001
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Country | US
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Telephone | 202-806-0066
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Fax | 202-806-0354
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Provider Business Mailing Address
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Address Line | 600 W ST. NW SUITE 326
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City | WASHINGTON
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State | DC
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Zip | 20059-0001
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Country | US
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Telephone | 202-806-0066
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Fax | 202-806-0354
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Authorized Official
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Title or Position | ASSOCIATE DEAN FOR CLINICAL AFFAIRS
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Name | MS. ANDREA D. JACKSON
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Credential | DDS, MS
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Telephone | 202-806-0064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DEN4077
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License Number State | DC
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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 |
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License Number State |
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