Provider Demographics
NPI:1790190130
Name:OPOKUADDO, NANA YAA (DDS, BDS, MBA)
Entity Type:Individual
Prefix:DR
First Name:NANA YAA
Middle Name:
Last Name:OPOKUADDO
Suffix:
Gender:F
Credentials:DDS, BDS, MBA
Other - Prefix:DR
Other - First Name:NANA YAA
Other - Middle Name:SAAH
Other - Last Name:POKU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BDS, MBA
Mailing Address - Street 1:2697 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43211-1663
Mailing Address - Country:US
Mailing Address - Phone:614-268-1243
Mailing Address - Fax:614-407-8482
Practice Address - Street 1:2697 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43211-1663
Practice Address - Country:US
Practice Address - Phone:614-268-1243
Practice Address - Fax:614-407-8482
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300243331223G0001X
VA04014144941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice