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NPI Code Detail

MEDICARE: AKLILU AMEHA

MEDICARE:   AKLILU  AMEHA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry30.024972OH

General Provider Information

NPI Number : 1942654363
Entity Type Code : Individual
Provider Name (Legal Business Name) : AKLILU AMEHA
Provider Business Mailing Address
First Line : 4656 RALSTON ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43214-1938
Country : US
Telephone Number : 614-668-5869
Fax Number :
Provider Business Practice Location Address
First Line : 8490 E NATIONAL RD
Second Line :
City : SOUTH VIENNA
State : OH
Zip : 45369-9707
Country : US
Telephone Number : 937-568-3302
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2016
Last Update Date : 12/11/2017

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