Provider Demographics
NPI:1942654363
Name:AMEHA, AKLILU
Entity Type:Individual
Prefix:
First Name:AKLILU
Middle Name:
Last Name:AMEHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4656 RALSTON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1938
Mailing Address - Country:US
Mailing Address - Phone:614-668-5869
Mailing Address - Fax:
Practice Address - Street 1:8490 E NATIONAL RD
Practice Address - Street 2:
Practice Address - City:SOUTH VIENNA
Practice Address - State:OH
Practice Address - Zip Code:45369-9707
Practice Address - Country:US
Practice Address - Phone:937-568-3302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0249721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice