Healthcare Provider Details

I. General information

NPI: 1124161161
Provider Name (Legal Business Name): TSEDAY MIMI MEKBIB DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5247 WISCONSIN AVE NW SUITE #3A
WASHINGTON DC
20015-2012
US

IV. Provider business mailing address

8823 TUCKERMAN LN
POTOMAC MD
20854-3166
US

V. Phone/Fax

Practice location:
  • Phone: 301-332-4094
  • Fax: 202-362-7410
Mailing address:
  • Phone: 301-983-8516
  • Fax: 301-983-2075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5957
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: