Provider Demographics
NPI:1538140462
Name:NWUGUWO, KIERIAN KEMJIKA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIERIAN
Middle Name:KEMJIKA
Last Name:NWUGUWO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 VESTAL PKWY E
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-3565
Mailing Address - Country:US
Mailing Address - Phone:607-777-1340
Mailing Address - Fax:607-777-1345
Practice Address - Street 1:4501 VESTAL PKWY E
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-3565
Practice Address - Country:US
Practice Address - Phone:607-777-1340
Practice Address - Fax:607-777-1345
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0435501122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01254264Medicaid