Healthcare Provider Details

I. General information

NPI: 1841041258
Provider Name (Legal Business Name): JEFFREY UJU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 W LAKE MEAD PKWY
HENDERSON NV
89015-7286
US

IV. Provider business mailing address

1329 ROSEMARY DR
BOLINGBROOK IL
60490-4940
US

V. Phone/Fax

Practice location:
  • Phone: 702-464-3090
  • Fax:
Mailing address:
  • Phone: 708-567-5657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8044
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: