Provider Demographics
NPI:1114273430
Name:NNADIUGWU, DANIEL NNADIUGWU (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:NNADIUGWU
Last Name:NNADIUGWU
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 1:1521 E DEBBIE LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3341
Mailing Address - Country:US
Mailing Address - Phone:817-225-6702
Mailing Address - Fax:
Practice Address - Street 1:1521 E DEBBIE LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3341
Practice Address - Country:US
Practice Address - Phone:817-225-6702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60885122300000X
PADS039601122300000X
TX28871122300000X
IADDS-09265122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3459224-01Medicaid
TX3459224-02Medicaid
TX3459224-04Medicaid
TX3459224-03Medicaid