Provider Demographics
NPI:1558851063
Name:WOLDESEMAIT, SHIWORKE
Entity Type:Individual
Prefix:
First Name:SHIWORKE
Middle Name:
Last Name:WOLDESEMAIT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 15TH ST NW APT 1002
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-2521
Mailing Address - Country:US
Mailing Address - Phone:615-260-6572
Mailing Address - Fax:
Practice Address - Street 1:2440 M ST NW STE 709
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1496
Practice Address - Country:US
Practice Address - Phone:202-750-8718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9260122300000X
DCDEN2000083122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist