Provider Demographics
NPI:1174687669
Name:YELENA OBHOLZ, D.D.S., P.L.L.C.
Entity Type:Organization
Organization Name:YELENA OBHOLZ, D.D.S., P.L.L.C.
Other - Org Name:AESTHETIC & FAMILY DENTISTRY OF WASHINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-364-8989
Mailing Address - Street 1:5101 WISCONSIN AVE NW STE 107
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4136
Mailing Address - Country:US
Mailing Address - Phone:202-364-8989
Mailing Address - Fax:202-244-9609
Practice Address - Street 1:5101 WISCONSIN AVE NW STE 107
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4136
Practice Address - Country:US
Practice Address - Phone:202-364-8989
Practice Address - Fax:202-244-9609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10005061223E0200X
DCDEN10005201223G0001X
DCDEN10005921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty