Healthcare Provider Details

I. General information

NPI: 1902471105
Provider Name (Legal Business Name): DAVID ONYIRIMBA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 PEACHTREE INDUSTRIAL BLVD STE 202
DULUTH GA
30097-8628
US

IV. Provider business mailing address

650 PONCE DE LEON AVE STE. 300 1164
ATLANTA GA
30308-1804
US

V. Phone/Fax

Practice location:
  • Phone: 678-385-9355
  • Fax:
Mailing address:
  • Phone: 860-559-4795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN122857
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: