Elbethel Dereje Defare, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401419020 Issued in VA

Practice address

1910 Thomson Dr
Lynchburg, VA 24501-1009

Phone

(434) 847-4581

NPI assigned

Jun 12, 2024

Last updated

Jul 26, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dentists on Grove Avenue PC

  • General Practice Dentistry
  • Richmond, VA
  • NPI 1962108142
  NPD (past)
• DRS. Holcomb, Savage, & Warwick, P.C.

  • General Practice Dentistry
  • Lynchburg, VA
  • NPI 1174732184
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1718150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721952000000",
    "number": "1033951603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43154 ASHLEY GREEN DR",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201487045",
            "telephone_number": "540-326-1711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 THOMSON DR",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245011009",
            "telephone_number": "434-847-4581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEFARE",
        "first_name": "ELBETHEL",
        "middle_name": "DEREJE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-12",
        "last_updated": "2024-07-26",
        "certification_date": "2024-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401419020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Guadalupe Declet Rodriguez
• William Walter Dedmond
• Janice Hope Deeds, PSYD
• Hannah Kate Deerman
• Benjamin Deets
• Thomas J Delaney, M.D.
• Victor Rafael Delgado Lazo, MD
• Nikoleta Delis, PA-C
• Carter A Delsorbo
• Octavio Demarchena

• General Practice Dentistry in Lynchburg, VA
• Providers in Lynchburg, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.