Provider Demographics
NPI:1255046843
Name:JDZ 19TH STREET, PLLC
Entity type:Organization
Organization Name:JDZ 19TH STREET, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZALEWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:216-402-9638
Mailing Address - Street 1:4660 KENMORE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1306
Mailing Address - Country:US
Mailing Address - Phone:703-823-2422
Mailing Address - Fax:
Practice Address - Street 1:1145 19TH ST NW STE 800
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3707
Practice Address - Country:US
Practice Address - Phone:202-296-7455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty