Provider Demographics
NPI:1639304009
Name:KWATENG, KWAME OPOKU
Entity Type:Individual
Prefix:
First Name:KWAME
Middle Name:OPOKU
Last Name:KWATENG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 GIBNER RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CARLISLE BARRACKS
Mailing Address - State:PA
Mailing Address - Zip Code:17013-5095
Mailing Address - Country:US
Mailing Address - Phone:717-245-3742
Mailing Address - Fax:
Practice Address - Street 1:450 GIBNER RD STE 2
Practice Address - Street 2:
Practice Address - City:CARLISLE BARRACKS
Practice Address - State:PA
Practice Address - Zip Code:17013-5095
Practice Address - Country:US
Practice Address - Phone:717-245-3742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014122961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice