Provider Demographics
NPI:1376293555
Name:WASHINGTON, PAMELA MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:MARIE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 PITTARD HILL PT
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-2222
Mailing Address - Country:US
Mailing Address - Phone:504-452-3733
Mailing Address - Fax:
Practice Address - Street 1:3350 BRECKINRIDGE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4959
Practice Address - Country:US
Practice Address - Phone:770-962-8396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GADN1227581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program