Provider Demographics
NPI:1255069472
Name:NNAGBO, CHINWENDU CALIS (DDS)
Entity type:Individual
Prefix:DR
First Name:CHINWENDU
Middle Name:CALIS
Last Name:NNAGBO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 S COBB DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-7859
Mailing Address - Country:US
Mailing Address - Phone:470-412-1981
Mailing Address - Fax:
Practice Address - Street 1:2900 S COBB DR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-7859
Practice Address - Country:US
Practice Address - Phone:470-412-1981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1233371223G0001X
VA04014181251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice