Provider Demographics
NPI:1497564991
Name:ANSAH, GLORIA NANA ADOMA (DDS)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:NANA ADOMA
Last Name:ANSAH
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 1:251 ORLEANS ST APT 201
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-4063
Mailing Address - Country:US
Mailing Address - Phone:443-907-8348
Mailing Address - Fax:
Practice Address - Street 1:6455 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-1808
Practice Address - Country:US
Practice Address - Phone:313-422-1282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016024231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice