Provider Demographics
NPI:1104837145
Name:NGO, TAIWO OHEOSA (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAIWO
Middle Name:OHEOSA
Last Name:NGO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3036 STONEGATE DR
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-8909
Mailing Address - Country:US
Mailing Address - Phone:419-861-7257
Mailing Address - Fax:
Practice Address - Street 1:1843 W ALEXIS RD
Practice Address - Street 2:SUITE 4
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-2353
Practice Address - Country:US
Practice Address - Phone:419-475-5450
Practice Address - Fax:419-475-5462
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21093122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2166294Medicaid