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NPI Code Detail

MEDICARE: ELITE DENTAL TAKOMA PARK

MEDICARE: ELITE DENTAL TAKOMA PARK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry14525MD
2261QD0000XDental Clinic/CenterDC

General Provider Information

NPI Number : 1679819098
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELITE DENTAL TAKOMA PARK
Provider Business Mailing Address
First Line : 6925 WILLOW STREET NW.
Second Line : SUITE#B106
City : WASHINGTON
State : DC
Zip : 20012-2000
Country : US
Telephone Number : 202-723-8284
Fax Number : 202-882-1127
Provider Business Practice Location Address
First Line : 6925 WILLOW STREET NW.
Second Line : SUITE#B106
City : WASHINGTON
State : DC
Zip : 20012-2000
Country : US
Telephone Number : 202-723-8284
Fax Number : 202-882-1127
Authorized Official
Title or Position : OWNER/DENTIST
Name : DR. KHALFANI D WALKER
Credential : DMD
Telephone Number : 202-723-8284
Provider Enumeration Date : 12/13/2012
Last Update Date : 06/26/2018

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Directions to “ELITE DENTAL TAKOMA PARK ” Practice Location

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