Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 2901020260 | MI |
NPI | 1043591472 |
---|---|
Provider Name | Dr. Ifechide Nwabueze |
First Address | Troy, MI 48083-1664 |
Second Address | Troy, MI 48083-1664 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2011 |
Last Update Date | 03/08/2015 |