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General NPI Number Information
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NPI Number | 1114453610
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Entity Type | Organization
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Legal Business Name | PRESIDENTIAL PEDIATRIC DENTISTRY & ORTHODONTICS
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Dates
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Enumeration Date | 05/04/2017
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Last Update Date | 05/04/2017
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Provider Practice Location Address
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Address Line | 350 EASTERN AVE NE
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City | WASHINGTON
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State | DC
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Zip | 20019-2833
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Country | US
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Telephone | 202-248-6288
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Fax | 202-248-6330
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Provider Business Mailing Address
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Address Line | 350 EASTERN AVE NE
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City | WASHINGTON
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State | DC
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Zip | 20019-2833
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Country | US
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Telephone | 202-248-6288
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Fax | 202-248-6330
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MR. KIDANEMARIAM ROZARIO
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Credential |
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Telephone | 202-248-6288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DEN1001643
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License Number State | DC
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