Provider Demographics
NPI:1528418951
Name:AGAPE DENTAL STUDIO LLC
Entity Type:Organization
Organization Name:AGAPE DENTAL STUDIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEKLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-820-8282
Mailing Address - Street 1:5555 COLUMBIA PIKE
Mailing Address - Street 2:SUITE #102
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-5852
Mailing Address - Country:US
Mailing Address - Phone:703-820-8282
Mailing Address - Fax:
Practice Address - Street 1:5555 COLUMBIA PIKE
Practice Address - Street 2:SUITE #102
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-5852
Practice Address - Country:US
Practice Address - Phone:703-820-8282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014122711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty