NPIMap

Organization Active NPI

Premiere Ortho-Pedo PLLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Washington, DC
National Provider Identifier
1003234360
Registry record updated Nov 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
DEN1000997 Issued in DC
Legal business name
PREMIERE ORTHO-PEDO PLLC
Practice address
437 Cedar St NW
Washington, DC 20012-1931
Phone
(202) 725-7735
NPI assigned
Apr 3, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Marvin Bonfuan NgwafonNPI 1922263391
Title
President
Phone
(202) 725-7735

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X DEN1001349 DC
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X DEN1000997 DC Primary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X

Addresses

Primary practice location

437 Cedar St NW
Washington, DC 20012-1931

Mailing address

PO Box 55474
Washington, DC 20040-5474
Phone (202) 725-7735

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1396483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699488000000",
    "number": "1003234360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 55474",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200405474",
            "telephone_number": "202-725-7735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "437 CEDAR ST NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200121931",
            "telephone_number": "202-725-7735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIERE ORTHO-PEDO PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-03",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-09",
        "status": "A",
        "authorized_official_last_name": "NGWAFON",
        "authorized_official_first_name": "MARVIN",
        "authorized_official_middle_name": "BONFUAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "202-725-7735"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "DC",
            "license": "DEN1001349",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "DC",
            "license": "DEN1000997",
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.