Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | D.0006720-C1 | AL |
NPI | 1194362848 |
---|---|
Provider Name | Avery Chikezie Anaje |
First Address | Cooper City, FL 33024 |
Second Address | Montgomery, AL 36108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2019 |
Last Update Date | 02/12/2019 |