Provider Demographics
NPI:1689300378
Name:NWANYA, INNOCENT CHIDOZIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:INNOCENT
Middle Name:CHIDOZIE
Last Name:NWANYA
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 1:1 HARBOR SQ APT 522
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-4530
Mailing Address - Country:US
Mailing Address - Phone:516-591-6338
Mailing Address - Fax:
Practice Address - Street 1:1708 ROUTE 47
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:NJ
Practice Address - Zip Code:08242-1406
Practice Address - Country:US
Practice Address - Phone:609-770-6136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02922300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist