Healthcare Provider Details

I. General information

NPI: 1093042111
Provider Name (Legal Business Name): SILESHI B ASSEMU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2009
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 WALLER ST
AUSTIN TX
78702-5240
US

IV. Provider business mailing address

2115 KRAMER LN SUITE 100
AUSTIN TX
78758-4013
US

V. Phone/Fax

Practice location:
  • Phone: 512-978-9895
  • Fax: 512-978-9900
Mailing address:
  • Phone: 512-978-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401412678
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number26384
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: