Provider Demographics
NPI:1083107494
Name:YADOGLAH, EMMANUEL (DDS)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:
Last Name:YADOGLAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 LINDA AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79763-2665
Mailing Address - Country:US
Mailing Address - Phone:432-333-4867
Mailing Address - Fax:432-333-4870
Practice Address - Street 1:2260 LINDA AVE STE 103
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763-2665
Practice Address - Country:US
Practice Address - Phone:432-333-4867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX342291223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice