Amy Berhanu Demissie DDS PC

Primary specialty

DentistTaxonomy code 122300000X

License

30174 Issued in CA

Legal business name

AMY BERHANU DEMISSIE DDS PC

Practice address

471 N San Gorgonio Ave
Banning, CA 92220

Phone

(951) 849-2888

Fax

(951) 849-1454

NPI assigned

Nov 14, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Amsale Berhanu Demissie

Title

President

Phone

(951) 849-2888

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Amsale Berhanu-Demissie, DDS.

  • General Practice Dentistry
  • Banning, CA
  • NPI 1891915492
  NPD (past)
• Jale Berhanu, DDS.

  • General Practice Dentistry
  • Banning, CA
  • NPI 1306066501
  NPD (past)
• David Demissie, DDS

  • General Practice Dentistry
  • San Bernardino, CA
  • NPI 1154812709
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215009246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "471 N SAN GORGONIO AVE",
            "city": "BANNING",
            "state": "CA",
            "postal_code": "92220",
            "telephone_number": "951-849-2888",
            "fax_number": "951-849-1454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "471 N SAN GORGONIO AVE",
            "city": "BANNING",
            "state": "CA",
            "postal_code": "92220",
            "telephone_number": "951-849-2888",
            "fax_number": "951-849-1454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMY BERHANU DEMISSIE DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DEMISSIE",
        "authorized_official_first_name": "AMSALE",
        "authorized_official_middle_name": "BERHANU",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-849-2888",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "30174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Virgie L Allen
• Nancy Almada Hernandez
• Jasmine Almazan
• Guadalupe Alonzo
• Guadalupe Alvarez
• Donald Lee Anderson, M.D.
• Matthias Anderson
• Megan Marie Anderson, PA
• Amy Mariko Andersson, M.A.
• Julie Ann Andrews, LCSW

• Dentist in Banning, CA
• Providers in Banning, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.