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General NPI Number Information
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NPI Number | 1255147237
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Entity Type | Organization
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Legal Business Name | ACK FAMILY DENTISTRY
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Dates
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Enumeration Date | 12/05/2024
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 11120 NEW HAMPSHIRE AVE STE 311
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City | SILVER SPRING
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State | MD
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Zip | 20904-2600
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Country | US
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Telephone | 301-770-0123
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Fax |
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Provider Business Mailing Address
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Address Line | 11120 NEW HAMPSHIRE AVE STE 311
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City | SILVER SPRING
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State | MD
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Zip | 20904-2600
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Country | US
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Telephone | 301-770-0123
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | KASSAHUN HAILU
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Credential | DDS
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Telephone | 301-770-0123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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