Provider Demographics
NPI:1295850394
Name:DAVIDSON DENTAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:DAVIDSON DENTAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-775-0022
Mailing Address - Street 1:1990 K ST NW
Mailing Address - Street 2:SUITE 15B
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-1103
Mailing Address - Country:US
Mailing Address - Phone:202-775-0022
Mailing Address - Fax:
Practice Address - Street 1:1990 K ST NW
Practice Address - Street 2:SUITE 15B
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1103
Practice Address - Country:US
Practice Address - Phone:202-775-0022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1001472122300000X
DCDEN1001366122300000X
DCDEN1000390122300000X
DC10013791223E0200X, 1223E0200X
DCDEN10013791223E0200X
DCDEN47801223G0001X
DCDEN23661223P0300X
DCDEN52241223P0300X
DCDEN10002121223P0700X
DCDEN10009671223S0112X
DC10007191223E0200X
DCDEN10008271223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty