Provider Demographics
NPI:1962064295
Name:TOMELL DUBOSE DDS PLLC
Entity type:Organization
Organization Name:TOMELL DUBOSE DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TOMELL
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBOSE
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:202-364-6550
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:202-364-6550
Mailing Address - Fax:202-478-2894
Practice Address - Street 1:5437 CONN 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:202-364-6550
Practice Address - Fax:202-478-2894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC12345OtherPRIVATE PRACTICE