Provider Demographics
NPI:1215231501
Name:AMBACHEW, MARIAMAWET DEMESSIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIAMAWET
Middle Name:DEMESSIE
Last Name:AMBACHEW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1352 S BURNSIDE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-2605
Mailing Address - Country:US
Mailing Address - Phone:213-448-0990
Mailing Address - Fax:
Practice Address - Street 1:601 S HIGH ST
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215
Practice Address - Country:US
Practice Address - Phone:661-725-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-01
Last Update Date:2011-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59826122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist