Provider Demographics
NPI:1104287036
Name:CHINATU P. EGO-OSUALA LLC
Entity type:Organization
Organization Name:CHINATU P. EGO-OSUALA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHINATU
Authorized Official - Middle Name:P
Authorized Official - Last Name:EGO-OSUALA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-326-1302
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-20
Last Update Date:2016-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD158031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty