Healthcare Provider Details

I. General information

NPI: 1013133974
Provider Name (Legal Business Name): FRIENDSHIP DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5247 WISCONSIN AVE NW STE 3A
WASHINGTON DC
20015-2012
US

IV. Provider business mailing address

5247 WISCONSIN AVE NW STE 3A
WASHINGTON DC
20015-2012
US

V. Phone/Fax

Practice location:
  • Phone: 202-362-7413
  • Fax: 202-362-7410
Mailing address:
  • Phone: 202-362-7413
  • Fax: 202-362-7410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number5886
License Number StateDC

VIII. Authorized Official

Name: DR. ELIDIA FIDEL
Title or Position: PEDIATRIC
Credential:
Phone: 202-362-7413