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General NPI Number Information
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NPI Number | 1992522692
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Entity Type | Individual
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Provider Name | EHIZOGIE PAUL ADEGHE DDS,MPH
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Gender | Male
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Dates
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Enumeration Date | 09/24/2024
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 7 FARRELL ST
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403-6113
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Country | US
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Telephone | 813-710-4378
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Fax |
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Provider Business Mailing Address
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Address Line | 2231 DISSTON ST
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City | PHILADELPHIA
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State | PA
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Zip | 19149-1917
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Country | US
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Telephone | 434-258-7195
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 0160134303
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License Number State | VT
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