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General NPI Number Information
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NPI Number | 1972046894
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Entity Type | Organization
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Legal Business Name | DIMPLES DENTAL SUITE, PC
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Dates
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Enumeration Date | 11/25/2016
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Last Update Date | 01/23/2018
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Provider Practice Location Address
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Address Line | 220 I ST NE SUITE 100
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City | WASHINGTON
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State | DC
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Zip | 20002-4365
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Country | US
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Telephone | 202-403-7242
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Fax |
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Provider Business Mailing Address
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Address Line | 220 I ST NE SUITE 100
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City | WASHINGTON
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State | DC
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Zip | 20002-4365
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Country | US
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Telephone | 202-827-4512
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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. TAKEISHA ROCHELLE PRESSON
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Credential | DDS
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Telephone | 202-827-4512
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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 | DEN100789
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License Number State | DC
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