Provider Demographics
NPI:1205388287
Name:CHUKWUKA, IFEANYI (DDS)
Entity type:Individual
Prefix:
First Name:IFEANYI
Middle Name:
Last Name:CHUKWUKA
Suffix:
Gender:
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:BRANCH HEALTH CLINIC WASHINGTON NAVY YARD
Mailing Address - Street 2:BUILDING 175, 915 N ST SE
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20374
Mailing Address - Country:US
Mailing Address - Phone:757-953-1897
Mailing Address - Fax:
Practice Address - Street 1:BRANCH HEALTH CLINIC WASHINGTON NAVY YARD
Practice Address - Street 2:BUILDING 175, 915 N ST SE
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20374
Practice Address - Country:US
Practice Address - Phone:202-433-2589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415430122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist