Provider Demographics
NPI:1891185278
Name:ELSABET TEKLE DDS LLC
Entity Type:Organization
Organization Name:ELSABET TEKLE DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ELSAABET
Authorized Official - Middle Name:
Authorized Official - Last Name:TEKLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-384-7800
Mailing Address - Street 1:2415 MUSGROVE RD
Mailing Address - Street 2:SUITE # 309
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5202
Mailing Address - Country:US
Mailing Address - Phone:301-384-7800
Mailing Address - Fax:301-384-5666
Practice Address - Street 1:2415 MUSGROVE RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5202
Practice Address - Country:US
Practice Address - Phone:301-384-7800
Practice Address - Fax:301-384-5666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11959332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment