Provider Demographics
NPI:1598889438
Name:NWOGU, SAMUEL C (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:C
Last Name:NWOGU
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 1:200 BIDDLE AVE STE 214
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3966
Mailing Address - Country:US
Mailing Address - Phone:302-595-4642
Mailing Address - Fax:302-595-4648
Practice Address - Street 1:200 BIDDLE AVE STE 214
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-3966
Practice Address - Country:US
Practice Address - Phone:302-595-4642
Practice Address - Fax:302-595-4648
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00012241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery