Provider Demographics
NPI:1710324637
Name:FITZPATRICK, LESLIE-ANNE (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:LESLIE-ANNE
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 RANDOLPH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5939
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3900 KANSAS AVE NW STE T-2
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5792
Practice Address - Country:US
Practice Address - Phone:202-983-5500
Practice Address - Fax:202-946-8787
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2021-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15406122300000X, 1223G0001X
390200000X
DCDEN1001362122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program