Provider Demographics
NPI:1881371011
Name:ABERA, SELOME WONDAFRASH (DDS)
Entity type:Individual
Prefix:DR
First Name:SELOME
Middle Name:WONDAFRASH
Last Name:ABERA
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 1:1960 SPECTRUM CIR SE # 915
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-6087
Mailing Address - Country:US
Mailing Address - Phone:704-713-1305
Mailing Address - Fax:
Practice Address - Street 1:427 W BANKHEAD HWY
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-1702
Practice Address - Country:US
Practice Address - Phone:770-456-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1231471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice