Healthcare Provider Details

I. General information

NPI: 1629267513
Provider Name (Legal Business Name): RENIS RUDI KAPSHTICA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 K ST NW #301
WASHINGTON DC
20006
US

IV. Provider business mailing address

2021 K ST NW #301
WASHINGTON DC
20006
US

V. Phone/Fax

Practice location:
  • Phone: 202-223-2921
  • Fax: 202-223-3533
Mailing address:
  • Phone: 202-223-2921
  • Fax: 202-223-3533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN1000366
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: