MEDICARE: DR. BINIAM TECLE D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	9669	NC

General Provider Information

NPI Number	:	1528485968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BINIAM TECLE D.D.S.

Provider Business Mailing Address
First Line	:	1008 NAYLOR RD
Second Line	:
City	:	KNIGHTDALE
State	:	NC
Zip	:	27545-7475
Country	:	US
Telephone Number	:	919-403-8028
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 WALTER REED RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-4409
Country	:	US
Telephone Number	:	910-864-9884
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2014
Last Update Date	:	03/24/2014

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