Provider Demographics
NPI:1588048102
Name:ADDERLEY DENTAL GROUP
Entity type:Organization
Organization Name:ADDERLEY DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TONI
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:ADDERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-722-1731
Mailing Address - Street 1:7826 EASTERN AVE NW STE 202
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1333
Mailing Address - Country:US
Mailing Address - Phone:202-722-1731
Mailing Address - Fax:202-722-1640
Practice Address - Street 1:7826 EASTERN AVE NW STE 202
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1333
Practice Address - Country:US
Practice Address - Phone:202-722-1731
Practice Address - Fax:202-722-1640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN5854122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC016068700Medicaid