Provider Demographics
NPI:1992522692
Name:ADEGHE, EHIZOGIE PAUL (DDS,MPH)
Entity type:Individual
Prefix:DR
First Name:EHIZOGIE
Middle Name:PAUL
Last Name:ADEGHE
Suffix:
Gender:M
Credentials:DDS,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 DISSTON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1917
Mailing Address - Country:US
Mailing Address - Phone:434-258-7195
Mailing Address - Fax:
Practice Address - Street 1:7 FARRELL ST
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6113
Practice Address - Country:US
Practice Address - Phone:813-710-4378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0160134303122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist