PS Dental DC 1, P.C.

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

PS DENTAL DC 1, P.C.

Practice address

4740 Connecticut Ave NW Apt 102
Washington, DC 20008-5604

Phone

(410) 761-0095

Fax

(202) 364-3274

NPI assigned

Mar 20, 2023

Organization subpart

Yes

Parent organization

PROSMILE HOLDING II LLCAs reported in NPPES

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

Authorized official

Name

Mrs. Simone Wilson, MPA

Title

Director of Credentialing

Phone

(848) 326-8840

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1679270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762732800000",
    "number": "1548962863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 WOODBRIDGE CENTER DR STE 520",
            "city": "WOODBRIDGE",
            "state": "NJ",
            "postal_code": "070951152",
            "telephone_number": "848-326-8840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4740 CONNECTICUT AVE NW APT 102",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200085604",
            "telephone_number": "410-761-0095",
            "fax_number": "202-364-3274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PS DENTAL DC 1, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROSMILE HOLDING II LLC",
        "enumeration_date": "2023-03-20",
        "last_updated": "2025-11-10",
        "certification_date": "2025-11-10",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "SIMONE",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "848-326-8840",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MPA"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Washington, DC
• Providers in Washington, DC by specialty
• Dentist in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2025; 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.