Individual
DR. SAMUEL TEKESTE HAGOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
13601 OFFICE PL, #202, WOODBRIDGE, VA 22192-4213
(703) 986-0434
Mailing address
2522 CARRIAGE LN, APT 2A, FREDERICKSBURG, VA 22401-7914
(301) 806-1632
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401414144
VA
Other
Enumeration date
07/24/2013
Last updated
07/24/2013
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