Provider Demographics
NPI:1336927169
Name:ELSABET TEKLE DDS LLC
Entity Type:Organization
Organization Name:ELSABET TEKLE DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELSABET
Authorized Official - Middle Name:
Authorized Official - Last Name:TEKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-384-7800
Mailing Address - Street 1:2415 MUSGROVE RD STE 309
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5223
Mailing Address - Country:US
Mailing Address - Phone:301-384-7800
Mailing Address - Fax:301-384-5666
Practice Address - Street 1:2415 MUSGROVE RD STE 309
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5223
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:2023-09-21
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty