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NPI Code Detail

MEDICARE: RAKEB A TILAHUN DDS

MEDICARE:   RAKEB A TILAHUN  DDS
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
1122300000XDentistDEN1001924DC
2122300000XDentist0401416244VA

General Provider Information

NPI Number : 1861028896
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAKEB A TILAHUN DDS
Provider Business Mailing Address
First Line : 8811 ROYAL DOULTON LN
Second Line :
City : FAIRFAX
State : VA
Zip : 22031-2179
Country : US
Telephone Number : 240-478-4487
Fax Number :
Provider Business Practice Location Address
First Line : 2837 ALABAMA AVE SE
Second Line :
City : WASHINGTON
State : DC
Zip : 20020-3000
Country : US
Telephone Number : 202-581-7600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2020
Last Update Date : 03/21/2020

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Directions to “ RAKEB A TILAHUN DDS” Practice Location

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