Individual
HIRUT MANMEKTOT KASSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1515 W 45TH AVE, GRIFFITH, IN 46319-3801
(219) 922-9007
Mailing address
1515 W 45TH AVE, GRIFFITH, IN 46319-3801
(219) 922-9007
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12013466A
IN
Other
Enumeration date
08/18/2020
Last updated
08/18/2020
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