Provider Demographics
NPI:1508229238
Name:NYAKUNDI, VICTOR M (DMD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:M
Last Name:NYAKUNDI
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 1:28 FAIRHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:MATTAPOISETT
Mailing Address - State:MA
Mailing Address - Zip Code:02739-1479
Mailing Address - Country:US
Mailing Address - Phone:508-535-4818
Mailing Address - Fax:508-758-1369
Practice Address - Street 1:28 FAIRHAVEN RD
Practice Address - Street 2:
Practice Address - City:MATTAPOISETT
Practice Address - State:MA
Practice Address - Zip Code:02739-1479
Practice Address - Country:US
Practice Address - Phone:508-535-4818
Practice Address - Fax:508-758-1369
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2016-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MADN18572281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program