Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DN1857764 | MA |
Y | 1223P0221X | Pediatric Dentist | 37125 | TX |
NPI | 1043729361 |
---|---|
Provider Name | Dr. Somtochi Olivia Akamnonu |
First Address | Chicago, IL 60654-4782 |
Second Address | Springfield, MA 01109-4101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2017 |
Last Update Date | 15/07/2021 |