MEDICARE: GOOD HOPE FAMILY DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DEN1000305	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578735122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD HOPE FAMILY DENTAL

Provider Business Mailing Address
First Line	:	PO BOX 4129
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-0129
Country	:	US
Telephone Number	:	202-581-7600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2645 NAYLOR RD SE STE 102
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-7255
Country	:	US
Telephone Number	:	202-581-7600
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DEREJE LEGESSE BEREDED
Credential	:	DDS
Telephone Number	:	202-581-7600

Provider Enumeration Date	:	03/24/2008
Last Update Date	:	03/24/2008

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Directions to “GOOD HOPE FAMILY DENTAL ” Practice Location

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