Provider Demographics
NPI:1598741043
Name:ETUFUGH, NGOZI N (DDS)
Entity Type:Individual
Prefix:DR
First Name:NGOZI
Middle Name:N
Last Name:ETUFUGH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 FRONT ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550
Mailing Address - Country:US
Mailing Address - Phone:516-292-6700
Mailing Address - Fax:516-485-8004
Practice Address - Street 1:33 FRONT ST
Practice Address - Street 2:SUITE 307
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550
Practice Address - Country:US
Practice Address - Phone:516-292-6700
Practice Address - Fax:516-485-8004
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0460621223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery