Provider Demographics
NPI:1033300967
Name:TADESSE TESFAMICHAEL, DDS
Entity Type:Organization
Organization Name:TADESSE TESFAMICHAEL, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TADESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:TESFAMICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-247-8001
Mailing Address - Street 1:920 N BASCOM AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1400
Mailing Address - Country:US
Mailing Address - Phone:408-247-8001
Mailing Address - Fax:408-247-8004
Practice Address - Street 1:920 N BASCOM AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1400
Practice Address - Country:US
Practice Address - Phone:408-247-8001
Practice Address - Fax:408-247-8004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty