Provider Demographics
NPI:1164762175
Name:NWANKWO, KELECHI (DDS)
Entity Type:Individual
Prefix:
First Name:KELECHI
Middle Name:
Last Name:NWANKWO
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 1:14900 MEMORIAL DR
Mailing Address - Street 2:230
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-5135
Mailing Address - Country:US
Mailing Address - Phone:832-271-5404
Mailing Address - Fax:
Practice Address - Street 1:14900 MEMORIAL DR
Practice Address - Street 2:230
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-5135
Practice Address - Country:US
Practice Address - Phone:832-271-5404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30841122300000X
MD155011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice