Individual
ESTHER RUSSTOM GHEBREMICHAEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
5430 E WASHINGTON ST, INDIANAPOLIS, IN 46219-6446
(317) 322-1840
Mailing address
201 W 8TH ST, SUITE 810, PUEBLO, CO 81003-3038
(719) 562-4447
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12011343A
IN
Other
Enumeration date
08/03/2009
Last updated
12/10/2010
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