=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811667058
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOLSTICE SMILES DENTAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2021
-----------------------------------------------------
Last Update Date | 09/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3900 KANSAS AVE NW STE T-2
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20011-5792
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-983-5500
-----------------------------------------------------
Fax | 202-946-8787
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3900 KANSAS AVE NW STE T-2
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20011-5792
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-983-5500
-----------------------------------------------------
Fax | 202-946-8787
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DENTIST
-----------------------------------------------------
Name | DR. LESLIE-ANNE FITZPATRICK
-----------------------------------------------------
Credential | DMD, MPH
-----------------------------------------------------
Telephone | 646-221-8788
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------