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General NPI Number Information
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NPI Number | 1588318992
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Entity Type | Organization
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Legal Business Name | DRIVEN DENTAL PLLC
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Dates
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Enumeration Date | 02/05/2022
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Last Update Date | 02/05/2022
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Provider Practice Location Address
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Address Line | 1520 6TH AVE STE 102
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City | TROY
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State | NY
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Zip | 12180-4584
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Country | US
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Telephone | 518-274-2660
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Fax |
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Provider Business Mailing Address
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Address Line | 1520 6TH AVE STE 102
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City | TROY
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State | NY
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Zip | 12180-4584
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Country | US
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Telephone | 518-274-2660
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PETER NNAMDI OKWEREKWU
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Credential | DMD, MPH
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Telephone | 612-423-7771
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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