Provider Demographics
NPI:1013783372
Name:DEMISSIE, YEMESRACH CHAKA (DDS)
Entity Type:Individual
Prefix:DR
First Name:YEMESRACH
Middle Name:CHAKA
Last Name:DEMISSIE
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 1:2606 FESSEY PARK RD APT 311
Mailing Address - Street 2:
Mailing Address - City:BERRY HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3168
Mailing Address - Country:US
Mailing Address - Phone:206-307-1414
Mailing Address - Fax:
Practice Address - Street 1:197 THOMPSON LN STE E
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-2415
Practice Address - Country:US
Practice Address - Phone:615-837-4525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000012357122300000X
WA61455535122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist