Provider Demographics
NPI:1003067778
Name:DUBOSE, TOMELL LEMART
Entity Type:Individual
Prefix:
First Name:TOMELL
Middle Name:LEMART
Last Name:DUBOSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5437 CONNECTICUT AVE NW
Mailing Address - Street 2:203
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2770
Mailing Address - Country:US
Mailing Address - Phone:202-364-6550
Mailing Address - Fax:202-364-7297
Practice Address - Street 1:5437 CONNECTICUT AVE NW
Practice Address - Street 2:203
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2770
Practice Address - Country:US
Practice Address - Phone:202-364-6550
Practice Address - Fax:202-364-7297
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC5980122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist