Healthcare Provider Details

I. General information

NPI: 1609702497
Provider Name (Legal Business Name): ABELL TESFAMARIAM HAILE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17020 RICHMOND HWY STE 101
DUMFRIES VA
22026-2495
US

IV. Provider business mailing address

152 MISTFLOWER CT
STAFFORD VA
22554-2640
US

V. Phone/Fax

Practice location:
  • Phone: 703-382-6545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401420116
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: