Healthcare Provider Details

I. General information

NPI: 1295996049
Provider Name (Legal Business Name): MIR ABDULLAH SOLUTI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 WISCONSIN AVE NW STE 309
WASHINGTON DC
20016-4130
US

IV. Provider business mailing address

5100 WISCONSIN AVE NW STE 309
WASHINGTON DC
20016-4130
US

V. Phone/Fax

Practice location:
  • Phone: 202-363-0088
  • Fax: 202-363-1536
Mailing address:
  • Phone: 202-363-0088
  • Fax: 202-363-1536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDEN5521
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: