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General NPI Number Information
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NPI Number | 1447652268
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Entity Type | Organization
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Legal Business Name | MY FACE MY SMILE
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Dates
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Enumeration Date | 09/24/2014
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Last Update Date | 09/24/2014
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Provider Practice Location Address
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Address Line | 2055 L ST NW SUITE 100
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City | WASHINGTON
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State | DC
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Zip | 20036-4983
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Country | US
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Telephone | 202-452-8989
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Fax | 202-452-6814
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Provider Business Mailing Address
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Address Line | 2055 L ST NW SUITE 100
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City | WASHINGTON
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State | DC
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Zip | 20036-4983
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Country | US
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Telephone | 202-452-8989
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Fax | 202-452-6814
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. SHAHROKH SOLTANI
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Credential | D.M.D.
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Telephone | 202-452-8989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DEN1001168
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License Number State | DC
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