Provider Demographics
NPI:1083214829
Name:EVENLY DC, PLLC
Entity Type:Organization
Organization Name:EVENLY DC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-805-5865
Mailing Address - Street 1:7402 FAIRFAX RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1241
Mailing Address - Country:US
Mailing Address - Phone:202-342-9600
Mailing Address - Fax:202-591-1377
Practice Address - Street 1:1619 CONNECTICUT AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-1013
Practice Address - Country:US
Practice Address - Phone:202-342-9600
Practice Address - Fax:202-591-1377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty