Provider Demographics
NPI:1861801805
Name:WASHINGTON ORAL SURGERY CENTER, LLC
Entity type:Organization
Organization Name:WASHINGTON ORAL SURGERY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSRUANCE SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MADALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PELT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-341-0041
Mailing Address - Street 1:1357 GOOD HOPE RD SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-6909
Mailing Address - Country:US
Mailing Address - Phone:301-341-0041
Mailing Address - Fax:
Practice Address - Street 1:1357 GOOD HOPE RD SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6909
Practice Address - Country:US
Practice Address - Phone:301-341-0041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery