Healthcare Provider Details

I. General information

NPI: 1417687070
Provider Name (Legal Business Name): BELEMA NGOZI OGBANGA-FARINAS DMD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BELEMA NGOZI OGBANGA DMD

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13983 W WADDELL RD STE 104
SURPRISE AZ
85379-8735
US

IV. Provider business mailing address

1401 E PUGET AVE APT 5
PHOENIX AZ
85020-6121
US

V. Phone/Fax

Practice location:
  • Phone: 623-232-3215
  • Fax:
Mailing address:
  • Phone: 623-698-4493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD011389
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: