Provider Demographics
NPI:1417686072
Name:UKAIGWE, BRYANT (DMD)
Entity Type:Individual
Prefix:
First Name:BRYANT
Middle Name:
Last Name:UKAIGWE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 3RD AVE APT 1919
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-2128
Mailing Address - Country:US
Mailing Address - Phone:708-768-6010
Mailing Address - Fax:
Practice Address - Street 1:1216 JOHN F KENNEDY BLVD
Practice Address - Street 2:FLOOR 2
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002
Practice Address - Country:US
Practice Address - Phone:708-768-6010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02958400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist