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General NPI Number Information
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NPI Number | 1962064295
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Entity Type | Organization
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Legal Business Name | TOMELL DUBOSE DDS PLLC
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Dates
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Enumeration Date | 07/08/2019
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Last Update Date | 07/08/2019
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Provider Practice Location Address
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Address Line | 5437 CONN AVE NW APT 203
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City | WASHINGTON
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State | DC
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Zip | 20015-2706
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Country | US
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Telephone | 202-364-6550
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Fax | 202-478-2894
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Provider Business Mailing Address
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Address Line | 5437 CONNECTICUT AVE NW APT 203
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City | WASHINGTON
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State | DC
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Zip | 20015-2706
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Country | US
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Telephone | 202-364-6550
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Fax | 202-478-2894
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Authorized Official
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Title or Position | CEO
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Name | DR. TOMELL DUBOSE
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Credential | DR
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Telephone | 202-364-6550
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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 |
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License Number State |
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