1871723106 NPI number — DR. OBIOMA ANULI PRINCEWILL DMD

Table of content: DR. OBIOMA ANULI PRINCEWILL DMD (NPI 1871723106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871723106 NPI number — DR. OBIOMA ANULI PRINCEWILL DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRINCEWILL
Provider First Name:
OBIOMA
Provider Middle Name:
ANULI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OKAFOR
Provider Other First Name:
OBIOMA
Provider Other Middle Name:
ANULI
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871723106
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1795 MAIN ST.
Provider Second Line Business Mailing Address:
SUITE 116
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-733-6651
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1795 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 116
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-733-6651
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2009

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:  DN1855185 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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