Provider Demographics
NPI:1336678499
Name:MORONTO, OGECHUKWU IFEYINWA (DMD)
Entity Type:Individual
Prefix:
First Name:OGECHUKWU
Middle Name:IFEYINWA
Last Name:MORONTO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 W PLUMSTEAD AVE APT B
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-1123
Mailing Address - Country:US
Mailing Address - Phone:484-321-1132
Mailing Address - Fax:
Practice Address - Street 1:2100 N BROAD ST STE 201
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1052
Practice Address - Country:US
Practice Address - Phone:215-362-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0413241223G0001X
TX378391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice