Individual
DJAVAN WHARTON-LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2045 UNIVERSITY BLVD E STE 204, HYATTSVILLE, MD 20783-4137
(626) 254-0207
(626) 254-8679
Mailing address
628 WEBSTER ST NW, WASHINGTON, DC 20011-4656
(301) 996-4055
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
0401417776
VA
1223E0200X
Endodontics
17787
MD
1223E0200X
Endodontics
65036
CA
1223E0200X
Endodontics
DGD.10963DS
SC
Other
Enumeration date
07/01/2014
Last updated
11/19/2024
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