Provider Demographics
NPI:1679396055
Name:DC DENTAL STUDIO PLLC
Entity type:Organization
Organization Name:DC DENTAL STUDIO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-714-3235
Mailing Address - Street 1:2501 EMERALD BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2605
Mailing Address - Country:US
Mailing Address - Phone:757-714-3235
Mailing Address - Fax:
Practice Address - Street 1:430 GALLOWAY ST NE STE B
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-6312
Practice Address - Country:US
Practice Address - Phone:202-496-1994
Practice Address - Fax:202-496-1998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental