Provider Demographics
NPI:1144516329
Name:EGO-OSUALA, CHINATU P (DDS)
Entity type:Individual
Prefix:DR
First Name:CHINATU
Middle Name:P
Last Name:EGO-OSUALA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7610 CARROLL AVE
Mailing Address - Street 2:480
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6384
Mailing Address - Country:US
Mailing Address - Phone:301-326-1302
Mailing Address - Fax:301-326-1092
Practice Address - Street 1:7610 CARROLL AVE
Practice Address - Street 2:480
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6384
Practice Address - Country:US
Practice Address - Phone:301-326-1302
Practice Address - Fax:301-326-1092
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-25
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MD158031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program