Provider Demographics
NPI:1265415251
Name:BEREDED, DEREJE LEGESSE (DDS)
Entity type:Individual
Prefix:DR
First Name:DEREJE
Middle Name:LEGESSE
Last Name:BEREDED
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 1:2837 ALABAMA AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020
Mailing Address - Country:US
Mailing Address - Phone:202-581-7600
Mailing Address - Fax:202-581-0070
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
Practice Address - Country:US
Practice Address - Phone:202-581-7600
Practice Address - Fax:202-581-7061
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC10003051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice