Data Notice: All results sourced from the public CMS NPPES NPI Registry (45 CFR Part 162), for healthcare administrative use only (credentialing, billing, insurance verification). Not for law enforcement or legal proceedings. Not affiliated with CMS, HHS, or the US Government. Verify critical details at npiregistry.cms.hhs.gov. No queries stored.
Export Provider Record NPI 1174109425
Life Bridge Dental Dc Pllc
Organization Subpart: NO
Active
NPI Number1174109425
NPI TypeNPI-2 Organization
SpecialtyDentist, General Practice
Provider Details
NPI1174109425
NPI TypeNPI-2 Organization
StatusActive
Enumeration Date2021-03-18
Last Updated2021-03-18
Authorized OfficialKenneth Sullivan
Director of Patient Revenue
Phone: 2126863686
Mailing Address5505 N Cumberland Ave Ste 307
Chicago, IL 60656-4761
United States
Phone: (212) 686-3686 | Fax: (615) 468-0325
📍 View Map
Primary Practice Address600 Pennsylvania Ave Nw
Washington, DC 20580-0001
United States
Phone: (212) 686-3686 | Fax: (615) 468-0325
📍 View Map
Taxonomy / Specialty
PrimaryTaxonomy Code & DescriptionStateLicense Number
Yes1223G0001X – Dentist, General Practice--
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About NPI 1174109425

Life Bridge Dental Dc Pllc is an organization registered in the CMS NPPES NPI Registry with NPI number 1174109425. The primary specialty listed is Dentist, General Practice. The organization is located in Washington, DC. This NPI is classified as a Type 2 (Organizational) NPI and is currently active. The NPI was first enumerated (assigned) on 2021-03-18. All data is sourced directly from the official CMS NPPES public API and is updated daily.

Frequently Asked Questions

What is NPI 1174109425?

NPI 1174109425 belongs to Life Bridge Dental Dc Pllc, a Dentist, General Practice in Washington, DC. It is a Type 2 Organizational NPI registered in the CMS NPPES NPI Registry.

Is NPI 1174109425 active?

The current status of NPI 1174109425 in the NPPES registry is Active. The record was last updated on 2021-03-18.

What specialty is NPI 1174109425?

NPI 1174109425 is classified under the taxonomy Dentist, General Practice. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.

How do I verify NPI 1174109425?

You can verify NPI 1174109425 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.

What address is on file for NPI 1174109425?

The primary practice address on file for NPI 1174109425 is 600 Pennsylvania Ave Nw, Washington, DC 20580-0001. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.

When was NPI 1174109425 issued?

NPI 1174109425 was first issued (enumerated) on 2021-03-18. The NPPES record was last updated on 2021-03-18.

Practice Location Map

Life Bridge Dental Dc Pllc is located at 600 Pennsylvania Ave Nw, Washington, DC. Use the map below to find directions or verify the practice location.

📍 600 Pennsylvania Ave Nw, Washington, DC 20580-0001  ·  Open in Google Maps ↗

Related Healthcare Providers

The following providers share the same practice location, specialty, or state as Life Bridge Dental Dc Pllc. All records sourced from the CMS NPPES registry.

Data Verified from CMS NPPES Last synced: 2026-07-09 · Source: npiregistry.cms.hhs.gov · 45 CFR Part 162