Healthcare Provider Details

I. General information

NPI: 1073430906
Provider Name (Legal Business Name): MESERET ALI YIMER DENTAL ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904A TYSONS LANDING CT
MC LEAN VA
22102-4712
US

IV. Provider business mailing address

1904A TYSONS LANDING CT
MC LEAN VA
22102-4712
US

V. Phone/Fax

Practice location:
  • Phone: 202-983-3355
  • Fax:
Mailing address:
  • Phone: 202-983-3355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberDENA001293
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number18914
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: