Provider Demographics
NPI:1255641536
Name:KINDRED, NICOLAS RAFAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:RAFAEL
Last Name:KINDRED
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 RHODE ISLAND AVE NE
Mailing Address - Street 2:104
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002
Mailing Address - Country:US
Mailing Address - Phone:202-271-1845
Mailing Address - Fax:
Practice Address - Street 1:2300 WASHINGTON PL NE
Practice Address - Street 2:SUITE 111S
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018
Practice Address - Country:US
Practice Address - Phone:202-515-8848
Practice Address - Fax:202-629-2962
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1001171122300000X
TX251061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice