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NPI Code Detail

MEDICARE: IJEOMA C. IGWE D.D.S.

MEDICARE: IJEOMA C. IGWE D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist63893CA

General Provider Information

NPI Number : 1194164079
Entity Type Code : Individual
Provider Name (Legal Business Name) : IJEOMA C. IGWE D.D.S.
Provider Business Mailing Address
First Line : 1711 ATLANTIC AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90813-2018
Country : US
Telephone Number : 562-591-4028
Fax Number :
Provider Business Practice Location Address
First Line : 1711 ATLANTIC AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90813-2018
Country : US
Telephone Number : 562-591-4028
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2013
Last Update Date : 08/25/2014

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