Provider Demographics
NPI:1356097018
Name:HADERA, SELAMAWIT (DH)
Entity Type:Individual
Prefix:
First Name:SELAMAWIT
Middle Name:
Last Name:HADERA
Suffix:
Gender:F
Credentials:DH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13120 E 19TH AVE STE C288
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2568
Mailing Address - Country:US
Mailing Address - Phone:303-315-6122
Mailing Address - Fax:
Practice Address - Street 1:13120 E 19TH AVE STE C288
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2568
Practice Address - Country:US
Practice Address - Phone:303-315-6122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist