Provider Demographics
NPI:1124793344
Name:YEHDEGO, AMAN MEHRETEAB (DDS)
Entity type:Individual
Prefix:
First Name:AMAN
Middle Name:MEHRETEAB
Last Name:YEHDEGO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 PENDLETON ST APT 10F
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3736
Mailing Address - Country:US
Mailing Address - Phone:260-445-0480
Mailing Address - Fax:
Practice Address - Street 1:105 N 12TH ST
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-6412
Practice Address - Country:US
Practice Address - Phone:803-764-3320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9766122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist