Healthcare Provider Details

I. General information

NPI: 1720175508
Provider Name (Legal Business Name): PATRICK BAMGBOYE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

957 RT 33 & PAXSON DENTAL HEALTH ASSOCIATES PA
HAMILTON NJ
08690
US

IV. Provider business mailing address

320 SOUTH MAIN STREET CORPORATE OFFICE 2ND FLR DENTAL HEALTH ASSOCIATES PA
PHILLIPSBURG NJ
08865
US

V. Phone/Fax

Practice location:
  • Phone: 609-587-5858
  • Fax: 609-587-4606
Mailing address:
  • Phone: 908-387-6120
  • Fax: 908-387-8322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDI020688
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: