Provider Demographics
NPI:1972046894
Name:DIMPLES DENTAL SUITE, PC
Entity Type:Organization
Organization Name:DIMPLES DENTAL SUITE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAKEISHA
Authorized Official - Middle Name:ROCHELLE
Authorized Official - Last Name:PRESSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-827-4512
Mailing Address - Street 1:220 I ST NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4365
Mailing Address - Country:US
Mailing Address - Phone:202-827-4512
Mailing Address - Fax:
Practice Address - Street 1:220 I ST NE
Practice Address - Street 2:SUITE 100
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4365
Practice Address - Country:US
Practice Address - Phone:202-403-7242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-25
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN100789122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC075593600Medicaid