Provider Demographics
NPI:1619002912
Name:ONYEJIUWA, ANDREW (DMD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:ONYEJIUWA
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 1:465 E 7TH ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-4844
Mailing Address - Country:US
Mailing Address - Phone:857-891-5288
Mailing Address - Fax:718-599-4912
Practice Address - Street 1:465 E 7TH ST APT 3B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-4844
Practice Address - Country:US
Practice Address - Phone:857-891-5288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50 054775122300000X
MA216041223G0001X
NY0547751223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice