Healthcare Provider Details

I. General information

NPI: 1902474786
Provider Name (Legal Business Name): KWAME OTUO-ACHAMPONG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 12/12/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3439 B MCGEHEE RD STE 22
MONTGOMERY AL
36111-3392
US

IV. Provider business mailing address

3322 W END AVE STE 400
NASHVILLE TN
37203-6805
US

V. Phone/Fax

Practice location:
  • Phone: 334-284-0228
  • Fax:
Mailing address:
  • Phone: 629-999-5014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD-0007128-C1
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD-0007128-C1
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: