Provider Demographics
NPI:1073150199
Name:DAMETEW, BEHAYLU AYALEW (DDS)
Entity Type:Individual
Prefix:DR
First Name:BEHAYLU
Middle Name:AYALEW
Last Name:DAMETEW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 PEABODY ST NW APT 409
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-1871
Mailing Address - Country:US
Mailing Address - Phone:202-629-6032
Mailing Address - Fax:
Practice Address - Street 1:14346 WARWICK BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-3814
Practice Address - Country:US
Practice Address - Phone:757-755-8771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014167871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice