Active NPI
Senait Habte Gebrewold, DMD
- General Practice Dentistry
- Evansville, IN
National Provider Identifier
1356624571
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12011734A
- Practice address
- 400 E Diamond Ave
Evansville, IN 47711-3714 - Phone
- (812) 461-2365
- NPI assigned
- Sep 23, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12011734A | IN | Primary |
Addresses
Primary practice location
400 E Diamond Ave
Evansville, IN 47711-3714
Mailing address
1090 Northchase Pkwy SE
Suite 290
Marietta, GA 30067-6405
Phone (678) 904-5665
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12011734A | IN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kool Smiles in-3, PC | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Evansville, IN
- NPI 1831284439
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316736000000",
"number": "1356624571",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1090 NORTHCHASE PKWY SE",
"address_2": "SUITE 290",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300676405",
"telephone_number": "678-904-5665"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 E DIAMOND AVE",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477113714",
"telephone_number": "812-461-2365"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GEBREWOLD",
"first_name": "SENAIT",
"middle_name": "HABTE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-23",
"last_updated": "2011-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IN",
"license": "12011734A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evansville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.