# AMY BERHANU DEMISSIE DDS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215009246
- **Authorized official:** DR. AMSALE BERHANU DEMISSIE (PRESIDENT)
- **Authorized official phone:** (951) 849-2888

## Contact information

- **Practice address:** 471 N SAN GORGONIO AVE, BANNING, CA 92220
- **Practice address phone:** (951) 849-2888
- **Practice address fax:** (951) 849-1454
- **Mailing address:** 471 N SAN GORGONIO AVE, BANNING, CA 92220
- **Mailing address phone:** (951) 849-2888
- **Mailing address fax:** (951) 849-1454

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 30174 | CA | Yes |

## Other

- **Enumeration date:** 11/14/2006
- **Last updated:** 08/22/2020