=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902698061
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NAZARETH FAMILY DENTAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2025
-----------------------------------------------------
Last Update Date | 05/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8501 COLESVILLE RD STE SUIT200
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20910-3322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-415-8222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1703 WILLOW SPRINGS DR
-----------------------------------------------------
City | SYKESVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21784-5601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-446-1404
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL DENTIST
-----------------------------------------------------
Name | DR. EDEN WOLDESENTBET AYANO
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 240-415-8222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------