Provider Demographics
NPI:1043591472
Name:NWABUEZE, IFECHIDE (DMD)
Entity Type:Individual
Prefix:DR
First Name:IFECHIDE
Middle Name:
Last Name:NWABUEZE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 LIVERNOIS RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1664
Mailing Address - Country:US
Mailing Address - Phone:248-528-0500
Mailing Address - Fax:248-528-0555
Practice Address - Street 1:2240 LIVERNOIS RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1664
Practice Address - Country:US
Practice Address - Phone:248-528-0500
Practice Address - Fax:248-528-0555
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010202601223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry