Healthcare Provider Details

I. General information

NPI: 1598889438
Provider Name (Legal Business Name): SAMUEL C NWOGU D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BIDDLE AVE STE 214
NEWARK DE
19702-3966
US

IV. Provider business mailing address

200 BIDDLE AVE STE 214
NEWARK DE
19702-3966
US

V. Phone/Fax

Practice location:
  • Phone: 302-595-4642
  • Fax: 302-595-4648
Mailing address:
  • Phone: 302-595-4642
  • Fax: 302-595-4648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberG1-0001224
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: