Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 5980 | DC |
NPI | 1003067778 |
---|---|
Provider Name | Tomell Lemart Dubose |
First Address | Washington, DC 20015-2770 |
Second Address | Washington, DC 20015-2770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2008 |
Last Update Date | 30/09/2008 |