Provider Demographics
NPI:1093943391
Name:CHIKWAVA, KUDZAI (DDS)
Entity Type:Individual
Prefix:DR
First Name:KUDZAI
Middle Name:
Last Name:CHIKWAVA
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 1:15011 BEMIS ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-1843
Mailing Address - Country:US
Mailing Address - Phone:919-423-6386
Mailing Address - Fax:
Practice Address - Street 1:300 W BROADWAY
Practice Address - Street 2:SUITE 6
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-9078
Practice Address - Country:US
Practice Address - Phone:712-256-6572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA086381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice