Provider Demographics
NPI:1861028896
Name:TILAHUN, RAKEB A (DDS)
Entity Type:Individual
Prefix:
First Name:RAKEB
Middle Name:A
Last Name:TILAHUN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8811 ROYAL DOULTON LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2179
Mailing Address - Country:US
Mailing Address - Phone:240-478-4487
Mailing Address - Fax:
Practice Address - Street 1:2837 ALABAMA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3000
Practice Address - Country:US
Practice Address - Phone:202-581-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-21
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1001924122300000X
VA0401416244122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist