Healthcare Provider Details

I. General information

NPI: 1538513635
Provider Name (Legal Business Name): NNEKA OBI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 1ST ST
HACKENSACK NJ
07601-3699
US

IV. Provider business mailing address

248 1ST ST
HACKENSACK NJ
07601-3699
US

V. Phone/Fax

Practice location:
  • Phone: 201-322-0032
  • Fax:
Mailing address:
  • Phone: 201-322-0032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI02679400
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: