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General NPI Number Information
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NPI Number | 1487359717
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Entity Type | Individual
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Provider Name | WONGELAWIT DELDIL TADESSE DDS
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Gender | Female
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Dates
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Enumeration Date | 04/04/2023
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 2417 MCGUIRE BLVD
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City | MC GUIRE AFB
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State | NJ
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Zip | 08641-5116
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Country | US
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Telephone | 609-754-3786
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Fax |
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Provider Business Mailing Address
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Address Line | 551 SETTLERS LANDING RD APT 405
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City | HAMPTON
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State | VA
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Zip | 23669-4251
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Country | US
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Telephone | 703-489-1056
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 134917919926
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License Number State | UT
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