Provider Demographics
NPI:1932458007
Name:DEMEWOZ, ASSEFA TESEGA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ASSEFA
Middle Name:TESEGA
Last Name:DEMEWOZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7746 GUNSTON PLZ
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-1897
Mailing Address - Country:US
Mailing Address - Phone:703-348-6969
Mailing Address - Fax:
Practice Address - Street 1:7746 GUNSTON PLZ
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-1897
Practice Address - Country:US
Practice Address - Phone:703-348-6969
Practice Address - Fax:540-808-1580
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD151761223G0001X
VA04014137251223G0001X
DCDEN10011701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice