Provider Demographics
NPI:1619636032
Name:CANDACE KWAKYE DDS, LLC
Entity Type:Organization
Organization Name:CANDACE KWAKYE DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:KWAKYE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-489-2332
Mailing Address - Street 1:3300 THEODORE R HAGANS DR NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-4320
Mailing Address - Country:US
Mailing Address - Phone:202-489-2332
Mailing Address - Fax:
Practice Address - Street 1:15434 NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20905-4163
Practice Address - Country:US
Practice Address - Phone:202-489-2332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental