Bereded Dental PC

Primary specialty

DentistTaxonomy code 122300000X

License

14917 Issued in MD

Legal business name

BEREDED DENTAL PC

Practice address

4813 Marlboro Pike
Capitol Heights, MD 20743-5283

Phone

(301) 420-2211

NPI assigned

Dec 6, 2012

Organization subpart

No

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

Authorized official

Name

Dereje Bereded, DDS

Title

Owner

Phone

(301) 420-2211

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1354752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354752000000",
    "number": "1841535549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4813 MARLBORO PIKE",
            "city": "CAPITOL HEIGHTS",
            "state": "MD",
            "postal_code": "207435283",
            "telephone_number": "301-420-2211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4813 MARLBORO PIKE",
            "city": "CAPITOL HEIGHTS",
            "state": "MD",
            "postal_code": "207435283",
            "telephone_number": "301-420-2211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEREDED DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-06",
        "last_updated": "2012-12-06",
        "status": "A",
        "authorized_official_last_name": "BEREDED",
        "authorized_official_first_name": "DEREJE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-420-2211",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MD",
            "license": "14917",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Capitol Heights, MD
• Providers in Capitol Heights, MD by specialty
• Dentist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2012; 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.