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General NPI Number Information
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NPI Number | 1912363573
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Entity Type | Organization
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Legal Business Name | FIDEL DENTAL GROUP, PLLC
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 01/12/2016
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Provider Practice Location Address
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Address Line | 4400 JENIFER ST NW SUITE 335
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City | WASHINGTON
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State | DC
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Zip | 20015-2113
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Country | US
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Telephone | 202-362-7413
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Fax |
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Provider Business Mailing Address
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Address Line | 4400 JENIFER ST NW SUITE 335
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City | WASHINGTON
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State | DC
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Zip | 20015-2113
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Country | US
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Telephone | 202-362-7413
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JULIANA BENINI
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Credential |
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Telephone | 202-362-7413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN1001296
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DEN5669
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DEN1000570
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License Number State | DC
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Taxonomy #4
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DEN1000355
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License Number State | DC
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Taxonomy #5
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DEN5886
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License Number State | DC
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