Provider Demographics
NPI:1619974300
Name:DOUMIT, ANTOINE (DMD CAGS)
Entity Type:Individual
Prefix:DR
First Name:ANTOINE
Middle Name:
Last Name:DOUMIT
Suffix:
Gender:M
Credentials:DMD CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 EYE ST NW
Mailing Address - Street 2:SUITE 8 C
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-2206
Mailing Address - Country:US
Mailing Address - Phone:202-549-9090
Mailing Address - Fax:
Practice Address - Street 1:23140 MOAKLEY ST
Practice Address - Street 2:SUITE 3
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2930
Practice Address - Country:US
Practice Address - Phone:301-997-0666
Practice Address - Fax:301-997-0402
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-10
Provider Licenses
StateLicense IDTaxonomies
MD109091223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics