Healthcare Provider Details

I. General information

NPI: 1770935686
Provider Name (Legal Business Name): AKPOVONA EFETURI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3867 UNION DEPOSIT RD
HARRISBURG PA
17109-5920
US

IV. Provider business mailing address

350 N CLARK ST SUITE 600
CHICAGO IL
60654-4712
US

V. Phone/Fax

Practice location:
  • Phone: 717-558-0042
  • Fax:
Mailing address:
  • Phone: 973-816-0968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS040975
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: