1790190130 NPI number — DR. NANA YAA OPOKUADDO DDS, BDS, MBA

Table of content: DR. NANA YAA OPOKUADDO DDS, BDS, MBA (NPI 1790190130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790190130 NPI number — DR. NANA YAA OPOKUADDO DDS, BDS, MBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OPOKUADDO
Provider First Name:
NANA YAA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS, BDS, MBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
POKU
Provider Other First Name:
NANA YAA
Provider Other Middle Name:
SAAH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
BDS, MBA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790190130
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2697 CLEVELAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43211-1663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-268-1243
Provider Business Mailing Address Fax Number:
614-407-8482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2697 CLEVELAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43211-1663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-268-1243
Provider Business Practice Location Address Fax Number:
614-407-8482
Provider Enumeration Date:
06/24/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  30024333 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 0401414494 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)