Provider Demographics
NPI:1093334971
Name:BAGNABANA, LAWKPEZI ABIDE YAWA
Entity Type:Individual
Prefix:
First Name:LAWKPEZI
Middle Name:ABIDE YAWA
Last Name:BAGNABANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 CEDAR CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-7720
Mailing Address - Country:US
Mailing Address - Phone:717-999-5605
Mailing Address - Fax:
Practice Address - Street 1:1509 CEDAR CLIFF DR
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-7720
Practice Address - Country:US
Practice Address - Phone:717-999-5655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-10
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS043396122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist