Provider Demographics
NPI:1801013891
Name:DR. ELIDIA C. FIDEL, DDS PLC
Entity Type:Organization
Organization Name:DR. ELIDIA C. FIDEL, DDS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIDIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:FIDEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-575-9899
Mailing Address - Street 1:5555 COLUMBIA PIKE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ARLINGTON
Mailing Address - State:VI
Mailing Address - Zip Code:22204-3117
Mailing Address - Country:US
Mailing Address - Phone:703-575-9899
Mailing Address - Fax:703-575-9890
Practice Address - Street 1:5555 COLUMBIA PIKE
Practice Address - Street 2:SUITE 102
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-5852
Practice Address - Country:US
Practice Address - Phone:703-575-9899
Practice Address - Fax:703-575-9890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014104911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty