Provider Demographics
NPI:1386988913
Name:GEBREHIWOT, FESEHATSION (FESAHA GEBREHIWOT)
Entity type:Individual
Prefix:DR
First Name:FESEHATSION
Middle Name:
Last Name:GEBREHIWOT
Suffix:
Gender:M
Credentials:FESAHA GEBREHIWOT
Other - Prefix:
Other - First Name:FESAHA
Other - Middle Name:
Other - Last Name:GEBREHIWOT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FESAHA GEBREHIWOT
Mailing Address - Street 1:9971 E SPEEDWAY BLVD
Mailing Address - Street 2:APT # 6205
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85748-1916
Mailing Address - Country:US
Mailing Address - Phone:206-849-8323
Mailing Address - Fax:
Practice Address - Street 1:510 STEVENS AVE SW
Practice Address - Street 2:APT # O203
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2379
Practice Address - Country:US
Practice Address - Phone:206-849-8323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 60302987122300000X
AZ8625122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist