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NPI Code Detail

MEDICARE: EMPIREDENTAL L.L.C.

MEDICARE: EMPIREDENTAL L.L.C.
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
11223G0001XGeneral Practice Dentistry0401415215VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11053793653OTHERNPI TYPE 2

General Provider Information

NPI Number : 1639629744
Entity Type Code : Organization
Provider Name (Legal Business Name) : EMPIREDENTAL L.L.C.
Provider Business Mailing Address
First Line : 5622 COLUMBIA PIKE
Second Line : SUITE 103
City : FALLS CHURCH
State : VA
Zip : 22041-2718
Country : US
Telephone Number : 703-575-8789
Fax Number :
Provider Business Practice Location Address
First Line : 5622 COLUMBIA PIKE
Second Line : SUITE 103
City : FALLS CHURCH
State : VA
Zip : 22041-2718
Country : US
Telephone Number : 703-575-8789
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. MULUALEM TESFAYE ASSEFA
Credential : D.D.S.
Telephone Number : 703-575-8789
Provider Enumeration Date : 10/12/2016
Last Update Date : 10/12/2016

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Directions to “EMPIREDENTAL L.L.C. ” Practice Location

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