Provider Demographics
NPI:1558537373
Name:DARIOUS N NWADIKE, DDS PC
Entity Type:Organization
Organization Name:DARIOUS N NWADIKE, DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARIOUS
Authorized Official - Middle Name:N
Authorized Official - Last Name:NWADIKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-319-8110
Mailing Address - Street 1:1025 E WEST CONNECTOR
Mailing Address - Street 2:SUITE 360
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-8513
Mailing Address - Country:US
Mailing Address - Phone:770-319-8110
Mailing Address - Fax:770-319-7446
Practice Address - Street 1:1025 E WEST CONNECTOR
Practice Address - Street 2:SUITE 360
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-8513
Practice Address - Country:US
Practice Address - Phone:770-319-8110
Practice Address - Fax:770-319-7446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0120561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty