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2012 Hecht Ave Ne Washington DC 20002-1668 | |
| (202) 669-6571 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2012 Hecht Ave Ne, Washington, District Of Columbia |
| Authorized Official Name and Position | Jarrett Caldwell (PRINCIPAL) |
| Authorized Official Contact | 2026696571 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
715 Ingraham St Nw Washington DC 20011-7707 Ph: (202) 669-6571 | 2012 Hecht Ave Ne Washington DC 20002-1668 Ph: (202) 669-6571 |
| NPI Number | 1164183562 |
|---|---|
| Provider Enumeration Date | 01/07/2022 |
| Last Update Date | 03/31/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164183562 | NPI | - | NPPES |
| 037888331 | Medicaid | DC | |
| 086310600 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Secondary |
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