Provider Demographics
NPI:1902896335
Name:DAKA, NGOZIKA U (DMD)
Entity Type:Individual
Prefix:DR
First Name:NGOZIKA
Middle Name:U
Last Name:DAKA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4155 FERNCREEK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2581
Mailing Address - Country:US
Mailing Address - Phone:910-323-8899
Mailing Address - Fax:910-486-6524
Practice Address - Street 1:4155 FERNCREEK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-2581
Practice Address - Country:US
Practice Address - Phone:910-323-8899
Practice Address - Fax:910-486-6524
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052085122300000X
NC8550122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02658244Medicaid