Provider Demographics
NPI:1356733869
Name:NWANDO UDOM DDS LLC
Entity type:Organization
Organization Name:NWANDO UDOM DDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NWANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:UDOM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-210-0505
Mailing Address - Street 1:2 KERRYANN CT
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-5156
Mailing Address - Country:US
Mailing Address - Phone:201-377-9120
Mailing Address - Fax:
Practice Address - Street 1:84 VERONICA AVE
Practice Address - Street 2:SUITE B1017
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3529
Practice Address - Country:US
Practice Address - Phone:732-210-0505
Practice Address - Fax:732-210-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-21
Last Update Date:2015-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02360900261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental