Provider Demographics
NPI:1053684654
Name:HOWARD UNIVERSITY
Entity Type:Organization
Organization Name:HOWARD UNIVERSITY
Other - Org Name:HU COLLEGE OF DENTISTRY FACULTY PRACTICE PLAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-806-0367
Mailing Address - Street 1:PO BOX 630321
Mailing Address - Street 2:HUCOD FACULTY PRACTICE PLAN
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21265-8321
Mailing Address - Country:US
Mailing Address - Phone:202-806-0367
Mailing Address - Fax:202-806-0354
Practice Address - Street 1:600 W ST NW
Practice Address - Street 2:SUITE 454
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20059-1022
Practice Address - Country:US
Practice Address - Phone:202-806-0367
Practice Address - Fax:202-806-0354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3906261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental