Itagegnehou Gedamu DMD PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

ITAGEGNEHOU GEDAMU DMD PLLC

Practice address

20991 Arsenal Street Rd
Watertown, NY 13601-4552

Phone

(315) 785-9620

NPI assigned

Nov 11, 2021

Organization subpart

No

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

Authorized official

Name

Itagegnehou Gedamu

Title

Owner

Phone

(315) 785-9620

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jamie L Neshkoff, RDH

  • Dental Hygienist
  • Watertown, NY
  • NPI 1699286807
  NPD (past)

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

{
    "created_epoch": "1636588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687219200000",
    "number": "1326704693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70887",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441900887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20991 ARSENAL STREET RD",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136014552",
            "telephone_number": "315-785-9620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ITAGEGNEHOU GEDAMU DMD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-11",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "status": "A",
        "authorized_official_last_name": "GEDAMU",
        "authorized_official_first_name": "ITAGEGNEHOU",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "315-785-9620"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renee Ingham, LMFT, MA/MS
• Innovative Physical Therapy Solutions PC
• Internal Medicine of Northern New York
• Heather Irobunda, M.D.
• Jeannine Ison, RN
• Marie Grace Sanchez Jacildo
• Arielle Lashay Jackson
• Nicolas Jaeggi, MD
• Akshat Jain, MD
• Christian Jakobsen

• All providers in Watertown, NY
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2023; 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.