Healthcare Provider Details

I. General information

NPI: 1861772279
Provider Name (Legal Business Name): DONALD CHIMEZIE OGBUEHI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 INTERNATIONAL CIR
COLORADO SPRINGS CO
80910-3127
US

IV. Provider business mailing address

1631 WETZEL AVE BLDG 815
FORT CARSON CO
80913-4095
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number31.012011
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number30023546
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.023546
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: