Healthcare Provider Details

I. General information

NPI: 1730540956
Provider Name (Legal Business Name): NEHIKHARE OGBEVOEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 CRENSHAW BLVD SUITE B
LOS ANGELES CA
90016-4264
US

IV. Provider business mailing address

1015 9TH ST APT 307
SANTA MONICA CA
90403-4101
US

V. Phone/Fax

Practice location:
  • Phone: 323-733-0969
  • Fax:
Mailing address:
  • Phone: 314-494-3266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number65292
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number65292
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number65292
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: