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Individual

DR. LATAVIAS DEMETRIUS ELLINGTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
7425 ARLINGTON RD, BETHESDA, MD 20814-5321
(301) 654-8024
Mailing address
4835 CORDELL AVE, #524, BETHESDA, MD 20814-3147

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
13834
MD
122300000X
Dentist
DEN1000572
DC
1223P0221X
Pediatric Dentistry
Primary
13834
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
522116489
TAX IDENTIFICATION NUMBER
MD
Enumeration date
03/07/2007
Last updated
12/01/2021
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