Provider Demographics
NPI:1295379626
Name:CONNECTICUT AVE DENTAL IMPLANT CENTER
Entity type:Organization
Organization Name:CONNECTICUT AVE DENTAL IMPLANT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:DEMONT
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-244-2616
Mailing Address - Street 1:5437 CONNECTICUT AVE NW APT 203
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2706
Mailing Address - Country:US
Mailing Address - Phone:202-244-2616
Mailing Address - Fax:
Practice Address - Street 1:5437 CONNECTICUT AVE NW APT 203
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2706
Practice Address - Country:US
Practice Address - Phone:202-244-2616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty