Organization
PREMIERE ORTHO-PEDO PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARVIN BONFUAN NGWAFON (PRESIDENT)
(202) 725-7735
Entity
Organization
Contact information
Practice address
437 CEDAR ST NW, WASHINGTON, DC 20012-1931
(202) 725-7735
Mailing address
PO BOX 55474, WASHINGTON, DC 20040-5474
(202) 725-7735
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
DEN1001349
DC
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DEN1000997
DC
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
04/03/2014
Last updated
11/09/2023
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