Provider Demographics
NPI:1801042882
Name:LIFE-ENHANCING DENTISTRY
Entity Type:Organization
Organization Name:LIFE-ENHANCING DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOCKLEAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-829-7600
Mailing Address - Street 1:437 CEDAR ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1931
Mailing Address - Country:US
Mailing Address - Phone:202-829-7600
Mailing Address - Fax:202-726-9397
Practice Address - Street 1:437 CEDAR ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1931
Practice Address - Country:US
Practice Address - Phone:202-829-7600
Practice Address - Fax:202-726-9397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC53991223G0001X
DCHYG1000355124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty