Provider Demographics
NPI:1467798348
Name:BEREDED GOOD HOPE DENTAL PLLC
Entity Type:Organization
Organization Name:BEREDED GOOD HOPE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREJE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEREDED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-581-7600
Mailing Address - Street 1:2641 NAYLOR ROAD SE STE 101
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-7255
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2641 NAYLOR ROAD SE STE 101
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-7255
Practice Address - Country:US
Practice Address - Phone:202-583-1810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1000305122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty