Provider Demographics
NPI:1710302690
Name:FAMILY FIRST DENTAL
Entity Type:Organization
Organization Name:FAMILY FIRST 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:BWANA
Authorized Official - Last Name:KALOMBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-505-2550
Mailing Address - Street 1:803 SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3462
Mailing Address - Country:US
Mailing Address - Phone:301-505-2550
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-28
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15372122300000X
DCDEN1001312122300000X
VA0401414224122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty