Individual
MRS. AMSALE BERHANU-DEMISSIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS.
Contact information
Practice address
471 N SAN GORGONIO AVE, BANNING, CA 92220-5523
(951) 849-2888
(951) 849-1454
Mailing address
471 N SAN GORGONIO AVE, BANNING, CA 92220-5523
(951) 849-2888
(951) 849-1454
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30174
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G9202801
DENTICAL
CA
01
—
G9202802
DENTICAL
CA
Enumeration date
04/26/2007
Last updated
07/08/2007
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