Provider Demographics
NPI:1124161161
Name:MEKBIB, TSEDAY MIMI (DDS)
Entity type:Individual
Prefix:DR
First Name:TSEDAY
Middle Name:MIMI
Last Name:MEKBIB
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 TUCKERMAN LN
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3166
Mailing Address - Country:US
Mailing Address - Phone:301-983-8516
Mailing Address - Fax:301-983-2075
Practice Address - Street 1:5247 WISCONSIN AVE NW
Practice Address - Street 2:SUITE #3A
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2012
Practice Address - Country:US
Practice Address - Phone:301-332-4094
Practice Address - Fax:202-362-7410
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC5957122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist