MEDICARE: DEREJE BEREDED DDS,LLC

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

General Provider Information

NPI Number	:	1821377755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEREJE BEREDED DDS,LLC

Provider Business Mailing Address
First Line	:	803 SOUTHERN AVE
Second Line	:
City	:	OXON HILL
State	:	MD
Zip	:	20745-3462
Country	:	US
Telephone Number	:	301-505-2550
Fax Number	:	301-505-6676

Provider Business Practice Location Address
First Line	:	803 SOUTHERN AVE
Second Line	:
City	:	OXON HILL
State	:	MD
Zip	:	20745-3462
Country	:	US
Telephone Number	:	301-505-2550
Fax Number	:	301-505-6676

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. DEREJE BEREDED
Credential	:
Telephone Number	:	301-505-2550

Provider Enumeration Date	:	08/09/2011
Last Update Date	:	07/05/2019

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