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General NPI Number Information
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NPI Number | 1306502802
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Entity Type | Individual
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Provider Name | GLORIA ENJUWEH DMD
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Gender | Female
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Dates
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Enumeration Date | 11/10/2021
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 1629 K ST NW
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City | WASHINGTON
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State | DC
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Zip | 20006-1602
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Country | US
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Telephone | 812-416-0101
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Fax |
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Provider Business Mailing Address
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Address Line | 15250 SIESTA KEY WAY APT 285
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City | ROCKVILLE
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State | MD
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Zip | 20850-5557
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Country | US
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Telephone | 240-643-3861
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN2000054
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License Number State | DC
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