Healthcare Provider Details

I. General information

NPI: 1104685759
Provider Name (Legal Business Name): CHIDEBELU AKOBUNDU DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 WHITE PLAINS RD
BRONX NY
10473-2631
US

IV. Provider business mailing address

28 WINFIELD AVE
MOUNT VERNON NY
10552-3416
US

V. Phone/Fax

Practice location:
  • Phone: 718-395-8350
  • Fax:
Mailing address:
  • Phone: 917-861-9149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number065893
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: