Provider Demographics
NPI:1356875462
Name:NWANKWO, KENECHUKWU (DDS)
Entity type:Individual
Prefix:
First Name:KENECHUKWU
Middle Name:
Last Name:NWANKWO
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 1:2817 GARDEN OAKS PL
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-4402
Mailing Address - Country:US
Mailing Address - Phone:972-816-8861
Mailing Address - Fax:
Practice Address - Street 1:5701 PRESIDENT GEORGE BUSH HWY STE 140
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-3694
Practice Address - Country:US
Practice Address - Phone:214-703-0703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX335881223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice