Healthcare Provider Details

I. General information

NPI: 1417686072
Provider Name (Legal Business Name): BRYANT UKAIGWE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 08/24/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 JOHN F KENNEDY BLVD FLOOR 2
BAYONNE NJ
07002
US

IV. Provider business mailing address

2319 3RD AVE APT 1919
NEW YORK NY
10035-2128
US

V. Phone/Fax

Practice location:
  • Phone: 708-768-6010
  • Fax:
Mailing address:
  • Phone: 708-768-6010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI02958400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: