Djavan Wharton-Lake

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

0401417776 Issued in VA

Practice address

2045 University Blvd E Ste 204
Hyattsville, MD 20783-4137

Phone

(626) 254-0207

Fax

(626) 254-8679

NPI assigned

Jul 1, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1404172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1174938906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "628 WEBSTER ST NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200114656",
            "telephone_number": "301-996-4055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2045 UNIVERSITY BLVD E STE 204",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "207834137",
            "telephone_number": "626-254-0207",
            "fax_number": "626-254-8679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHARTON-LAKE",
        "first_name": "DJAVAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-07-01",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "CA",
            "license": "65036",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "SC",
            "license": "DGD.10963DS",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "MD",
            "license": "17787",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "VA",
            "license": "0401417776",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kenya White, DC
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• Endodontics in Hyattsville, MD
• Providers in Hyattsville, MD by specialty
• Endodontics in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.