Provider Demographics
NPI:1730540956
Name:OGBEVOEN, NEHIKHARE (DDS)
Entity type:Individual
Prefix:DR
First Name:NEHIKHARE
Middle Name:
Last Name:OGBEVOEN
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 1:1015 9TH ST
Mailing Address - Street 2:APT 307
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4101
Mailing Address - Country:US
Mailing Address - Phone:314-494-3266
Mailing Address - Fax:
Practice Address - Street 1:3015 CRENSHAW BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-4264
Practice Address - Country:US
Practice Address - Phone:323-733-0969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65292122300000X, 1223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0221XDental ProvidersDentistPediatric Dentistry
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics