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General NPI Number Information
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NPI Number | 1558851063
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Entity Type | Individual
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Provider Name | SHIWORKE WOLDESEMAIT
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Gender | Female
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Dates
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Enumeration Date | 05/10/2018
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Last Update Date | 04/05/2024
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Provider Practice Location Address
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Address Line | 2440 M ST NW STE 709
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City | WASHINGTON
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State | DC
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Zip | 20037-1496
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Country | US
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Telephone | 202-750-8718
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Fax |
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Provider Business Mailing Address
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Address Line | 910 15TH ST NW APT 1002
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City | WASHINGTON
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State | DC
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Zip | 20005-2521
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Country | US
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Telephone | 615-260-6572
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 9260
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN2000083
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License Number State | DC
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