Active NPI
Yohannes Ghirmay Hadera, DDS
- General Practice Dentistry
- Phoenix, AZ
National Provider Identifier
1952994600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 38107
- Practice address
- 420 W Watkins Rd
Phoenix, AZ 85003-2830 - Phone
- (602) 254-3338
- NPI assigned
- Feb 13, 2021
- Sex
- Male
- Sole proprietor
- Yes
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 | 38107 | TX | Primary |
Addresses
Primary practice location
420 W Watkins Rd
Phoenix, AZ 85003-2830
Mailing address
8445 N 23Rd Ave Apt 165
Phoenix, AZ 85021-4815
Phone (602) 509-8741
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 |
|---|---|---|---|
| 38107 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1613174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648684800000",
"number": "1952994600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8445 N 23RD AVE APT 165",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850214815",
"telephone_number": "602-509-8741"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 W WATKINS RD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850032830",
"telephone_number": "602-254-3338"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HADERA",
"first_name": "YOHANNES",
"middle_name": "GHIRMAY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-02-13",
"last_updated": "2022-03-31",
"certification_date": "2022-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "38107",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.