Healthcare Provider Details

I. General information

NPI: 1972395853
Provider Name (Legal Business Name): MUNACHISO IFUDU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 FAIRVIEW AVE
HUDSON NY
12534-1203
US

IV. Provider business mailing address

14015 GODWIT ST
CLARKSBURG MD
20871-3419
US

V. Phone/Fax

Practice location:
  • Phone: 516-439-1988
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number065892
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: