Healthcare Provider Details

I. General information

NPI: 1457109191
Provider Name (Legal Business Name): CHIDERA MARIANNE NWOBU DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 VOORHEES TOWN CTR
VOORHEES NJ
08043-1911
US

IV. Provider business mailing address

300 ALEXANDER CT APT 502
PHILADELPHIA PA
19103-1160
US

V. Phone/Fax

Practice location:
  • Phone: 215-282-8000
  • Fax:
Mailing address:
  • Phone: 862-438-0051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22DI03160700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: