Provider Demographics
NPI:1881261907
Name:GEORGETOWN ORTHODONTICS, PLLC
Entity type:Organization
Organization Name:GEORGETOWN ORTHODONTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:301-802-4322
Mailing Address - Street 1:4434 MACARTHUR BLVD NW STE 201
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-2550
Mailing Address - Country:US
Mailing Address - Phone:202-333-2200
Mailing Address - Fax:202-333-2260
Practice Address - Street 1:4434 MACARTHUR BLVD NW STE 201
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2550
Practice Address - Country:US
Practice Address - Phone:202-333-2200
Practice Address - Fax:202-333-2260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1972735017OtherDOCTOR NPI