Provider Demographics
NPI:1134986383
Name:MOLLA, ETSEGENET ABEBE (DMD)
Entity type:Individual
Prefix:
First Name:ETSEGENET
Middle Name:ABEBE
Last Name:MOLLA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ETSEGENET
Other - Middle Name:ABEBE
Other - Last Name:MOLLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:11601 JOHNS HOPKINS RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1832
Mailing Address - Country:US
Mailing Address - Phone:240-714-9697
Mailing Address - Fax:
Practice Address - Street 1:11601 JOHNS HOPKINS RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1832
Practice Address - Country:US
Practice Address - Phone:240-714-9697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18426122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist