Provider Demographics
NPI:1013133974
Name:FRIENDSHIP DENTAL CARE
Entity Type:Organization
Organization Name:FRIENDSHIP DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-362-7413
Mailing Address - Street 1:5247 WISCONSIN AVE NW
Mailing Address - Street 2:STE 3A
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2012
Mailing Address - Country:US
Mailing Address - Phone:202-362-7413
Mailing Address - Fax:202-362-7410
Practice Address - Street 1:5247 WISCONSIN AVE NW
Practice Address - Street 2:STE 3A
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2012
Practice Address - Country:US
Practice Address - Phone:202-362-7413
Practice Address - Fax:202-362-7410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC58861223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty