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Individual

KASSAHUN H HAILU

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.D.S

Contact information

Practice address
11300 ROCKVILLE PIKE STE 711, ROCKVILLE, MD 20852-3011
(303) 770-0123
(301) 770-2877
Mailing address
11300 ROCKVILLE PIKE STE 711, ROCKVILLE, MD 20852-3011
(301) 770-0123
(301) 770-2877

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12267
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
013173300
MD
Enumeration date
12/19/2007
Last updated
12/04/2019
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