Abyssinia Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

ABYSSINIA DENTAL LLC

Doing business as

Abys Dental

Practice address

4041 Powder Mill Rd Ste 100
Beltsville, MD 20705-3106

Phone

(301) 477-1005

NPI assigned

Nov 29, 2018

Last updated

Nov 29, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Derejew Kifle Tessema, DDS

Title

Dentist

Phone

(301) 477-1005

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Abys Dental Doing business as

Locations

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

{
    "created_epoch": "1543449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543449600000",
    "number": "1851861199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4041 POWDER MILL RD STE 100",
            "city": "BELTSVILLE",
            "state": "MD",
            "postal_code": "207053106",
            "telephone_number": "301-477-1005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4041 POWDER MILL RD STE 100",
            "city": "BELTSVILLE",
            "state": "MD",
            "postal_code": "207053106",
            "telephone_number": "301-477-1005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABYSSINIA DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-29",
        "last_updated": "2018-11-29",
        "status": "A",
        "authorized_official_last_name": "TESSEMA",
        "authorized_official_first_name": "DEREJEW",
        "authorized_official_middle_name": "KIFLE",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "301-477-1005",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "17075979",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "131458100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Abys Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Beltsville, MD
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2018; 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.