Healthcare Provider Details

I. General information

NPI: 1275512683
Provider Name (Legal Business Name): SENNAY MUSSIE STEFANOS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 KINKAID RD
ANNAPOLIS MD
21402-1006
US

IV. Provider business mailing address

695 KINKAID RD
ANNAPOLIS MD
21402-1006
US

V. Phone/Fax

Practice location:
  • Phone: 410-293-3902
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401410682
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401410682
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: