Healthcare Provider Details

I. General information

NPI: 1083393474
Provider Name (Legal Business Name): ALEXANDER UCHE NWOGU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date: 02/20/2024
Reactivation Date: 08/04/2025

III. Provider practice location address

4214 S FARM ROAD 135
SPRINGFIELD MO
65810-3716
US

IV. Provider business mailing address

4214 S FARM ROAD 135
SPRINGFIELD MO
65810-3716
US

V. Phone/Fax

Practice location:
  • Phone: 417-289-0000
  • Fax:
Mailing address:
  • Phone: 417-289-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2025024518
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: