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General NPI Number Information
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NPI Number | 1356733869
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Entity Type | Organization
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Legal Business Name | NWANDO UDOM DDS LLC
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Dates
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Enumeration Date | 02/21/2015
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Last Update Date | 02/21/2015
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Provider Practice Location Address
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Address Line | 84 VERONICA AVE SUITE B1017
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City | SOMERSET
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State | NJ
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Zip | 08873-3529
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Country | US
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Telephone | 732-210-0505
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Fax | 732-210-0506
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Provider Business Mailing Address
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Address Line | 2 KERRYANN CT
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City | MONROE
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State | NJ
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Zip | 08831-5156
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Country | US
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Telephone | 201-377-9120
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. NWANDO UDOM
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Credential | DDS
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Telephone | 732-210-0505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 22DI02360900
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License Number State | NJ
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