Provider Demographics
NPI:1215995683
Name:MUOGHALU, SANDRA NKECHI (DDS)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:NKECHI
Last Name:MUOGHALU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 W. HAYWARD DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712
Mailing Address - Country:US
Mailing Address - Phone:417-466-7196
Mailing Address - Fax:417-466-4081
Practice Address - Street 1:1050 W. HAYWARD DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:MO
Practice Address - Zip Code:65712
Practice Address - Country:US
Practice Address - Phone:417-466-7196
Practice Address - Fax:417-466-4081
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS71691223G0001X
MO20160125111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice