Provider Demographics
NPI:1982321287
Name:NWACHOKOR DENTAL PRACTICE, INC.
Entity Type:Organization
Organization Name:NWACHOKOR DENTAL PRACTICE, INC.
Other - Org Name:HAPPY TEETH DENTAL COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NWACHOKOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-363-0061
Mailing Address - Street 1:155 E LOMITA BLVD
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-6305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:155 E LOMITA BLVD
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-6305
Practice Address - Country:US
Practice Address - Phone:310-363-0061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty