Jale Berhanu, DDS.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

40539 Issued in CA

Practice address

471 N San Gorgonio Ave
Banning, CA 92220-5523

Phone

(951) 849-2888

Fax

(951) 849-2140

NPI assigned

Apr 27, 2007

Last updated

Feb 9, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Amy Berhanu Demissie DDS PC

  • Dentist
  • Banning, CA
  • NPI 1215009246
  NPD (past)

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

{
    "created_epoch": "1177632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328745600000",
    "number": "1306066501",
    "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": "922205523",
            "telephone_number": "951-849-2888",
            "fax_number": "951-849-2140"
        },
        {
            "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": "922205523",
            "telephone_number": "951-849-2888",
            "fax_number": "951-849-2140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERHANU",
        "first_name": "JALE",
        "name_prefix": "Ms.",
        "credential": "DDS.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-27",
        "last_updated": "2012-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "40539",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "000819656",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTICAL",
            "identifier": "G9202801",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTICAL",
            "identifier": "G9202802",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shelly Marie Belmonte
• Blanca Estela Benitez
• Kim E Bennett, P.A.
• Sarah D Bergeson
• Amsale Berhanu-Demissie, DDS.
• Taylor D Berry
• Erica Lynn Tarango Bhambi
• Dalonna Blackwell
• Jorge Alnozo Blackwood Jr.
• Isabelle Blair, M.S. CCC-SLP

• General Practice Dentistry in Banning, CA
• Providers in Banning, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2012; 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.