Provider Demographics
NPI:1144763558
Name:CLAIRE P. CARGILL DDS PC
Entity Type:Organization
Organization Name:CLAIRE P. CARGILL DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-758-0154
Mailing Address - Street 1:1009 E ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-2847
Mailing Address - Country:US
Mailing Address - Phone:202-547-2491
Mailing Address - Fax:
Practice Address - Street 1:1009 E ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-2847
Practice Address - Country:US
Practice Address - Phone:202-547-2491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN5626261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental