Provider Demographics
NPI:1205289428
Name:NWAIGBO, CHUKWUJINDU ONYEMORDI (DDS)
Entity type:Individual
Prefix:DR
First Name:CHUKWUJINDU
Middle Name:ONYEMORDI
Last Name:NWAIGBO
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 1:476 HERSCHEL ST
Mailing Address - Street 2:APT 1
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3608
Mailing Address - Country:US
Mailing Address - Phone:832-512-2448
Mailing Address - Fax:
Practice Address - Street 1:476 HERSCHEL ST
Practice Address - Street 2:APT 1
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3608
Practice Address - Country:US
Practice Address - Phone:832-512-2448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND137411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice