Provider Demographics
NPI:1255147237
Name:ACK FAMILY DENTISTRY
Entity type:Organization
Organization Name:ACK FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KASSAHUN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAILU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-770-0123
Mailing Address - Street 1:11120 NEW HAMPSHIRE AVE STE 311
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2600
Mailing Address - Country:US
Mailing Address - Phone:301-770-0123
Mailing Address - Fax:
Practice Address - Street 1:11120 NEW HAMPSHIRE AVE STE 311
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2600
Practice Address - Country:US
Practice Address - Phone:301-770-0123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental