Provider Demographics
NPI:1912020363
Name:EBODA, NNENNA NWANYIRIUBA (BDS)
Entity Type:Individual
Prefix:DR
First Name:NNENNA
Middle Name:NWANYIRIUBA
Last Name:EBODA
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 S LINDEN RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5475
Mailing Address - Country:US
Mailing Address - Phone:810-230-9800
Mailing Address - Fax:810-230-9802
Practice Address - Street 1:2222 S LINDEN RD
Practice Address - Street 2:SUITE K
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5475
Practice Address - Country:US
Practice Address - Phone:810-230-9800
Practice Address - Fax:810-230-9802
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010178871223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI01002114OtherHEALTH PLUS INSURANCE ID#