Provider Demographics
NPI:1962935221
Name:AGUNWAH, SOMTOCHUKWU
Entity type:Individual
Prefix:
First Name:SOMTOCHUKWU
Middle Name:
Last Name:AGUNWAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 WHITNEY RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3143
Mailing Address - Country:US
Mailing Address - Phone:864-479-8841
Mailing Address - Fax:
Practice Address - Street 1:371 WHITNEY RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3143
Practice Address - Country:US
Practice Address - Phone:864-479-8841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014167391223P0221X
NC129571223P0221X
MD167041223P0221X
SCDGD.104101223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry