Organization
EMPIREDENTAL L.L.C.
Active
Other names
Empire Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MULUALEM TESFAYE ASSEFA D.D.S. (OWNER)
(703) 575-8789
Entity
Organization
Contact information
Practice address
5622 COLUMBIA PIKE, SUITE 103, FALLS CHURCH, VA 22041-2718
(703) 575-8789
Mailing address
5622 COLUMBIA PIKE, SUITE 103, FALLS CHURCH, VA 22041-2718
(703) 575-8789
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401415215
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053793653
NPI TYPE 2
—
Enumeration date
10/12/2016
Last updated
10/12/2016
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