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General NPI Number Information
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NPI Number | 1356398556
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Entity Type | Individual
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Provider Name | WALTER OKUMU NGAJI-OKUMU DDS
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Gender | Male
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 10/07/2011
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Provider Practice Location Address
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Address Line | 1131 OLIVE ST
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City | COATESVILLE
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State | PA
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Zip | 19320-3518
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Country | US
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Telephone | 610-466-9545
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Fax | 610-466-9545
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Provider Business Mailing Address
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Address Line | 13 BUCK RUN LANE
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City | MALVERN
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State | PA
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Zip | 19355-1609
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Country | US
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Telephone | 610-466-9545
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Fax | 610-466-9545
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 13418
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901018732
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS036492
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License Number State | PA
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