Provider Demographics
NPI:1639629744
Name:EMPIREDENTAL L.L.C.
Entity Type:Organization
Organization Name:EMPIREDENTAL L.L.C.
Other - Org Name:EMPIRE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MULUALEM
Authorized Official - Middle Name:TESFAYE
Authorized Official - Last Name:ASSEFA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-575-8789
Mailing Address - Street 1:5622 COLUMBIA PIKE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-2718
Mailing Address - Country:US
Mailing Address - Phone:703-575-8789
Mailing Address - Fax:
Practice Address - Street 1:5622 COLUMBIA PIKE
Practice Address - Street 2:SUITE 103
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-2718
Practice Address - Country:US
Practice Address - Phone:703-575-8789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014152151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1053793653OtherNPI TYPE 2