Provider Demographics
NPI:1376754424
Name:ALTMON, EPHRAIM LORENZO (DDS)
Entity Type:Individual
Prefix:DR
First Name:EPHRAIM
Middle Name:LORENZO
Last Name:ALTMON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8605 KITTAMA DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3179
Mailing Address - Country:US
Mailing Address - Phone:240-606-2699
Mailing Address - Fax:
Practice Address - Street 1:4301 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 453
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2304
Practice Address - Country:US
Practice Address - Phone:202-470-3676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10005621223P0221X
MD162081223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry