Healthcare Provider Details

I. General information

NPI: 1053793653
Provider Name (Legal Business Name): MULUALEM TESFAYE ASSEFA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5570 SILVER HILL RD
DISTRICT HEIGHTS MD
20747-1104
US

IV. Provider business mailing address

1313 SOUTHERN AVE COMMERCIAL
OXON HILL MD
20745
US

V. Phone/Fax

Practice location:
  • Phone: 301-202-2222
  • Fax:
Mailing address:
  • Phone: 301-747-3474
  • Fax: 301-747-1181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number16016
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401415215
License Number StateVA
# 3
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: