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General NPI Number Information
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NPI Number | 1982734075
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Entity Type | Individual
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Provider Name | LATAVIAS DEMETRIUS ELLINGTON DDS
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Gender | Male
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 7425 ARLINGTON RD
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City | BETHESDA
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State | MD
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Zip | 20814-5321
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Country | US
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Telephone | 301-654-8024
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Fax |
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Provider Business Mailing Address
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Address Line | 4835 CORDELL AVE #524
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City | BETHESDA
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State | MD
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Zip | 20814-3147
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 13834
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN1000572
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 13834
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License Number State | MD
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