1700246899 NPI number — DR. FRANKLYN OSAIGBOVO AGUEBOR DMD

Table of content: DR. FRANKLYN OSAIGBOVO AGUEBOR DMD (NPI 1700246899)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700246899 NPI number — DR. FRANKLYN OSAIGBOVO AGUEBOR DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AGUEBOR
Provider First Name:
FRANKLYN
Provider Middle Name:
OSAIGBOVO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700246899
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
818 RIVERFRONT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30901-1968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-368-0668
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1775 GRAND CONCOURSE
Provider Second Line Business Practice Location Address:
6TH FLOOR (DEPARTMENT OF DENTISTRY)
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10453-8202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-901-8110
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/02/2016

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: 390200000X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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