Provider Demographics
NPI:1427243013
Name:ZELLEKE, MESFIN WOLDE (DDS)
Entity type:Individual
Prefix:DR
First Name:MESFIN
Middle Name:WOLDE
Last Name:ZELLEKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 GARRISONVILLE RD
Mailing Address - Street 2:205
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-1500
Mailing Address - Country:US
Mailing Address - Phone:703-354-0686
Mailing Address - Fax:
Practice Address - Street 1:392 GARRISONVILLE RD
Practice Address - Street 2:205
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1500
Practice Address - Country:US
Practice Address - Phone:703-354-0686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014117851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice