Healthcare Provider Details

I. General information

NPI: 1447546361
Provider Name (Legal Business Name): ANNETTE MARIE OGUNNOWO D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2037 SE 29TH ST
TOPEKA KS
66605-2457
US

IV. Provider business mailing address

2037 SE 29TH ST
TOPEKA KS
66605-2457
US

V. Phone/Fax

Practice location:
  • Phone: 785-267-9500
  • Fax: 785-267-9505
Mailing address:
  • Phone: 785-267-9500
  • Fax: 785-267-9505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number60826
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: