Provider Demographics
NPI:1770624454
Name:ROXBOROUGH, JOHN W (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:ROXBOROUGH
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 1:3020 14TH ST NW
Mailing Address - Street 2:SUITE 402B
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-6865
Mailing Address - Country:US
Mailing Address - Phone:202-745-4300
Mailing Address - Fax:202-462-3428
Practice Address - Street 1:1328 W ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5718
Practice Address - Country:US
Practice Address - Phone:202-610-7160
Practice Address - Fax:202-610-7164
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN34961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice