Healthcare Provider Details

I. General information

NPI: 1548947401
Provider Name (Legal Business Name): NANA ADJEIWAA AFUA BOAKYE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 ARSENAL ST
WATERTOWN NY
13601-2504
US

IV. Provider business mailing address

238 ARSENAL ST
WATERTOWN NY
13601-2504
US

V. Phone/Fax

Practice location:
  • Phone: 315-782-9450
  • Fax: 833-305-0396
Mailing address:
  • Phone: 315-782-9450
  • Fax: 833-305-0396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number065650
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: