Provider Demographics
NPI:1417687070
Name:OGBANGA-FARINAS, BELEMA NGOZI (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:BELEMA
Middle Name:NGOZI
Last Name:OGBANGA-FARINAS
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:DR
Other - First Name:BELEMA
Other - Middle Name:NGOZI
Other - Last Name:OGBANGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1401 E PUGET AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-6121
Mailing Address - Country:US
Mailing Address - Phone:623-698-4493
Mailing Address - Fax:
Practice Address - Street 1:13983 W WADDELL RD STE 104
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-8735
Practice Address - Country:US
Practice Address - Phone:623-232-3215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0113891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice