Provider Demographics
NPI:1124298823
Name:HUNPONU-WUSU, LINDA (DMD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:HUNPONU-WUSU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:HUNPONU-WUSU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:372 MOUNT PROSPECT AVE
Mailing Address - Street 2:APT F7
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-2110
Mailing Address - Country:US
Mailing Address - Phone:862-237-9361
Mailing Address - Fax:
Practice Address - Street 1:639 MOUNT PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-3109
Practice Address - Country:US
Practice Address - Phone:973-481-3900
Practice Address - Fax:973-481-2999
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053630122300000X
NJ22DI02412201122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00665274Medicaid
NJ0305677Medicaid
NY13-2960287OtherTAX ID
NY00665274Medicaid