Provider Demographics
NPI:1689943938
Name:KIDDIE CAVITY CARE
Entity Type:Organization
Organization Name:KIDDIE CAVITY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EPHRAIM
Authorized Official - Middle Name:LORENZO
Authorized Official - Last Name:ALTMON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-470-3676
Mailing Address - Street 1:3743 BRANCH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-1408
Mailing Address - Country:US
Mailing Address - Phone:240-606-2699
Mailing Address - Fax:202-470-2124
Practice Address - Street 1:3743 BRANCH AVE STE A
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1408
Practice Address - Country:US
Practice Address - Phone:240-606-2699
Practice Address - Fax:202-470-2124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1000562122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty