Provider Demographics
NPI:1720227044
Name:GEORGETOWN DENTAL CLINIC, PC, INC.
Entity Type:Organization
Organization Name:GEORGETOWN DENTAL CLINIC, PC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-965-3051
Mailing Address - Street 1:1605 FOXHALL RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-2030
Mailing Address - Country:US
Mailing Address - Phone:202-965-3051
Mailing Address - Fax:202-965-3099
Practice Address - Street 1:1605 FOXHALL RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2030
Practice Address - Country:US
Practice Address - Phone:202-965-3051
Practice Address - Fax:202-965-3099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC52561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty