Healthcare Provider Details

I. General information

NPI: 1326789645
Provider Name (Legal Business Name): HELENA TAFESSE DANIEL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2022
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 DONALD LEE HOLLOWELL PKWY NW
ATLANTA GA
30318-6653
US

IV. Provider business mailing address

3350 TOLEDO TER APT 313
HYATTSVILLE MD
20782-3200
US

V. Phone/Fax

Practice location:
  • Phone: 404-523-6571
  • Fax:
Mailing address:
  • Phone: 817-412-8678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN123007
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: