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Individual
MS. JALE BERHANU
Active
Individual
MS. JALE BERHANU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS.
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
40539
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000819656
UNITED CONCORDIA
CA
01
—
G9202801
DENTICAL
CA
01
—
G9202802
DENTICAL
CA
Enumeration date
04/27/2007
Last updated
02/09/2012
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