Provider Demographics
NPI:1760065338
Name:202 DENTAL PLLC
Entity Type:Organization
Organization Name:202 DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TEFESEHET
Authorized Official - Middle Name:
Authorized Official - Last Name:MESFIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-670-8820
Mailing Address - Street 1:315 H ST NE STE C
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-7180
Mailing Address - Country:US
Mailing Address - Phone:202-670-8820
Mailing Address - Fax:
Practice Address - Street 1:315 H ST NE STE C
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-7180
Practice Address - Country:US
Practice Address - Phone:202-670-8820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental