Provider Demographics
NPI:1699191247
Name:GOODHOPE FAMILY DENTAL
Entity Type:Organization
Organization Name:GOODHOPE FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:B
Authorized Official - Last Name:KALOMBO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-505-2550
Mailing Address - Street 1:2645 NAYLOR RD SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-7255
Mailing Address - Country:US
Mailing Address - Phone:202-581-7600
Mailing Address - Fax:202-583-1845
Practice Address - Street 1:803 SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3462
Practice Address - Country:US
Practice Address - Phone:301-505-2550
Practice Address - Fax:301-505-6676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty