Basic Information
| Provider Information | |||||||||
| NPI: | 1649415738 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNITY HEALTH CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 43564 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200109564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015901400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3720 MARTIN LUTHER KING JR AVE SE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200321548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027157900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2008 | ||||||||
| LastUpdateDate: | 12/04/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DUVERNEY | ||||||||
| AuthorizedOfficialFirstName: | LORETTA | ||||||||
| AuthorizedOfficialMiddleName: | MICHELLE | ||||||||
| AuthorizedOfficialTitleorPosition: | DENTIST | ||||||||
| AuthorizedOfficialTelephone: | 2027156576 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | DEN1000555 | DC | Y | Agencies | Community/Behavioral Health |
No ID Information.