Provider Demographics
NPI:1538443221
Name:COOMBS, ALBERT A III (DMD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:A
Last Name:COOMBS
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 BENNING RD NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4827
Mailing Address - Country:US
Mailing Address - Phone:202-396-9679
Mailing Address - Fax:202-396-9773
Practice Address - Street 1:2415 BENNING RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4827
Practice Address - Country:US
Practice Address - Phone:202-396-9679
Practice Address - Fax:202-396-9773
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1001057122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist