Provider Demographics
NPI:1275828980
Name:GAVUA, EMMANUEL KWEKU
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:KWEKU
Last Name:GAVUA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 PATRICIA DR APT D
Mailing Address - Street 2:
Mailing Address - City:YEADON
Mailing Address - State:PA
Mailing Address - Zip Code:19050-4051
Mailing Address - Country:US
Mailing Address - Phone:267-694-3266
Mailing Address - Fax:
Practice Address - Street 1:1100 FLORIDA AVE, BOX 220
Practice Address - Street 2:LSU SCHOOL OF DENTISTRY
Practice Address - City:NEW ORLEANS,
Practice Address - State:LA
Practice Address - Zip Code:70119-2799
Practice Address - Country:US
Practice Address - Phone:504-941-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program