Provider Demographics
NPI:1235786328
Name:WASHINGTON AIRWAY & WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:WASHINGTON AIRWAY & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:WILBUR
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:202-463-2090
Mailing Address - Street 1:1625 K ST NW FRNT 1
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-1610
Mailing Address - Country:US
Mailing Address - Phone:202-463-2090
Mailing Address - Fax:202-463-8768
Practice Address - Street 1:1625 K ST NW FRNT 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1610
Practice Address - Country:US
Practice Address - Phone:202-463-2090
Practice Address - Fax:202-463-8768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty