1609066802 NPI number — WASHINGTON CENTER FOR IMAGE DENTISTRY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609066802 NPI number — WASHINGTON CENTER FOR IMAGE DENTISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WASHINGTON CENTER FOR IMAGE DENTISTRY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DRS INGBER,PRESTIPINO & KRISTALLIS LLC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609066802
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7830 OLD GEORGETOWN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20814-2432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-652-2300
Provider Business Mailing Address Fax Number:
301-907-9236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7830 OLD GEORGETOWN ROAD
Provider Second Line Business Practice Location Address:
SUITE 260
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-652-2300
Provider Business Practice Location Address Fax Number:
301-907-9236
Provider Enumeration Date:
07/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PRESTIPINO
Authorized Official First Name:
VINCENT
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
301-652-2300

Provider Taxonomy Codes

  • Taxonomy code: 1223P0700X , with the licence number:  6965 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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