MEDICARE: GOOD HOPE FAMILY DENTAL PLLC

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	DEN1000305	DC

General Provider Information

NPI Number	:	1861737561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD HOPE FAMILY DENTAL PLLC

Provider Business Mailing Address
First Line	:	2645 NAYLOR RD SE STE 102
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-7255
Country	:	US
Telephone Number	:	202-581-7600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2645 NAYLOR RD SE STE 102
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-7255
Country	:	US
Telephone Number	:	202-581-7600
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DEREJE L BEREDED
Credential	:	DDS
Telephone Number	:	202-581-7600

Provider Enumeration Date	:	12/06/2012
Last Update Date	:	12/06/2012

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Directions to “GOOD HOPE FAMILY DENTAL PLLC ” Practice Location

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