DJAVAN WHARTON-LAKE NPI 1174938906

NPI Information

  • NPI: 1174938906
  • Provider Name: DJAVAN WHARTON-LAKE
  • Classification: Dentist - 1223E0200X
  • Specialization: Endodontics
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 2045 UNIVERSITY BLVD E STE 204
    HYATTSVILLE, MD
    ZIP 20783
  • Phone: (626) 254-0207

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NPI Details

Djavan Wharton-lake is an endodontics dentist in Hyattsville, MD. The provider is the branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. Djavan Wharton-lake NPI is 1174938906. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2045 UNIVERSITY BLVD E STE 204
HYATTSVILLE, MD
ZIP 20783-137
Phone: (626) 254-0207
Fax: (626) 254-8679

The NPI 1174938906 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 7/1/2014 and was last updated on 11/19/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223E0200XDentistEndodontics65036CALIFORNIANo
21223E0200XDentistEndodonticsDGD.10963DSSOUTH CAROLINANo
31223E0200XDentistEndodontics17787MARYLANDNo
41223E0200XDentistEndodontics0401417776VIRGINIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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