Provider Demographics
NPI:1891241675
Name:OKWEREKWU, PETER NNAMDI (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:NNAMDI
Last Name:OKWEREKWU
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 6TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-4584
Mailing Address - Country:US
Mailing Address - Phone:518-274-2660
Mailing Address - Fax:
Practice Address - Street 1:1520 6TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-4584
Practice Address - Country:US
Practice Address - Phone:518-274-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857421122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist