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General NPI Number Information
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NPI Number | 1356624571
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Entity Type | Individual
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Provider Name | SENAIT HABTE GEBREWOLD DMD
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Gender | Male
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Dates
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Enumeration Date | 09/23/2011
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Last Update Date | 09/23/2011
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Provider Practice Location Address
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Address Line | 400 E DIAMOND AVE
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City | EVANSVILLE
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State | IN
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Zip | 47711-3714
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Country | US
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Telephone | 812-461-2365
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Fax |
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Provider Business Mailing Address
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Address Line | 1090 NORTHCHASE PKWY SE SUITE 290
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City | MARIETTA
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State | GA
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Zip | 30067-6405
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Country | US
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Telephone | 678-904-5665
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12011734A
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License Number State | IN
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