=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619545068
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | K STREET DENTAL, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2021
-----------------------------------------------------
Last Update Date | 06/14/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 WASHINGTON CIR NW STE 306
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20037-2311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-315-0856
-----------------------------------------------------
Fax | 202-775-8332
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 WASHINGTON CIR NW STE 306
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20037-2311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-315-0856
-----------------------------------------------------
Fax | 202-775-8332
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MRS. DANA MARIE COLASANTO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-494-3176
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------